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General NPI Number Information
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NPI Number | 1952577108
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL OPHTHALMICS
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 4605 RUSAN ST
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-255-9787
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Fax | 320-255-1046
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Provider Business Mailing Address
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Address Line | PO BOX 1264 4605 RUSAN ST
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-255-9787
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Fax | 320-255-1046
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. AL BARROW
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Credential |
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Telephone | 320-255-9787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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