MEDICARE: MRS. PATRICIA LOUISE OSBORNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	149254	VA

General Provider Information

NPI Number	:	1326170895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA LOUISE OSBORNE

Provider Business Mailing Address
First Line	:	5245 VINCENT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-3318
Country	:	US
Telephone Number	:	612-287-9625
Fax Number	:	612-287-9625

Provider Business Practice Location Address
First Line	:	3989 CENTRAL AVE NE
Second Line	:	SUITE 200F
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3900
Country	:	US
Telephone Number	:	651-331-0617
Fax Number	:	612-287-9625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	07/08/2007

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