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General NPI Number Information
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NPI Number | 1982028312
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Entity Type | Organization
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Legal Business Name | G MABIE EYECARE LLC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 1955 GENEVA AVE N
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City | OAKDALE
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State | MN
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Zip | 55128-4108
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Country | US
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Telephone | 651-702-2504
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Fax |
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Provider Business Mailing Address
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Address Line | 1955 GENEVA AVE N
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City | OAKDALE
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State | MN
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Zip | 55128-4108
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Country | US
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Telephone | 651-702-2504
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARA MABIE
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Credential | OD
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Telephone | 651-702-2504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 096034
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2593
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License Number State | MN
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