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General NPI Number Information
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NPI Number | 1982769501
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Entity Type | Organization
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Legal Business Name | CALVIN OPTOMETRY PLLC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 1995 BURNS AVE. SUITE B
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City | SAINT PAUL
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State | MN
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Zip | 55119-4906
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Country | US
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Telephone | 651-739-5173
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Fax | 651-739-8907
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Provider Business Mailing Address
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Address Line | 2540 EAGLE VALLEY DR
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City | WOODBURY
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State | MN
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Zip | 55129-4206
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Country | US
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Telephone | 651-738-2758
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | DONALD WAYNE CALVIN
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Credential | O.D.
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Telephone | 651-739-5173
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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 | 1643
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License Number State | MN
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