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General NPI Number Information
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NPI Number | 1992937338
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Entity Type | Organization
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Legal Business Name | ROSEVILLE OPTICIANS
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 1790 LEXINGTON AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55113-6167
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Country | US
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Telephone | 651-489-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 1790 LEXINGTON AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55113-6167
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Country | US
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Telephone | 651-489-8800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT B KENNEDY
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Credential | O.D.
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Telephone | 651-489-8800
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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 |
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License Number State |
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