MEDICARE: OWL OPTICAL INC.

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1376145151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OWL OPTICAL INC.

Provider Business Mailing Address
First Line	:	4318 UPTON AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1555
Country	:	US
Telephone Number	:	612-367-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	4318 UPTON AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1555
Country	:	US
Telephone Number	:	612-367-4106
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER ALLEN HANSEN
Credential	:
Telephone Number	:	612-978-9871

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “OWL OPTICAL INC. ” Practice Location

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