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General NPI Number Information
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NPI Number | 1982993135
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Entity Type | Organization
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Legal Business Name | 20/20 EYECARE & OPTICS, LLC
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 1510 125TH AVE NE
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City | BLAINE
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State | MN
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Zip | 55449-4749
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Country | US
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Telephone | 763-755-9380
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Fax | 763-755-9415
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Provider Business Mailing Address
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Address Line | 1510 125TH AVE NE
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City | BLAINE
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State | MN
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Zip | 55449-4749
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MRS. ANGELA MUSLAND
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Credential | O.D.
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Telephone | 651-746-9066
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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 | 2966
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License Number State | MN
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