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General NPI Number Information
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NPI Number | 1962527754
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Entity Type | Organization
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Legal Business Name | THE EYE DOCTORS OFFICE, PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 03/26/2023
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Provider Practice Location Address
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Address Line | 747 LAKE ST E
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City | WAYZATA
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State | MN
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Zip | 55391-1712
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Country | US
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Telephone | 952-404-2020
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Fax | 952-404-0202
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Provider Business Mailing Address
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Address Line | 747 LAKE ST E
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City | WAYZATA
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State | MN
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Zip | 55391-1712
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Country | US
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Telephone | 952-404-2020
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Fax | 952-404-0202
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY P HAUPERT
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Credential | OD
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Telephone | 952-404-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | MN
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