MEDICARE: MARY J FEMRITE OD

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	152WC0802X	Corneal and Contact Management Optometrist	2773	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598750952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY J FEMRITE OD

Provider Business Mailing Address
First Line	:	308 5TH AVE S
Second Line	:	SUITE 110
City	:	COLD SPRING
State	:	MN
Zip	:	56320-2343
Country	:	US
Telephone Number	:	320-685-5400
Fax Number	:	320-685-3506

Provider Business Practice Location Address
First Line	:	308 5TH AVE S
Second Line	:	SUITE 110
City	:	COLD SPRING
State	:	MN
Zip	:	56320-2343
Country	:	US
Telephone Number	:	320-685-5400
Fax Number	:	320-685-3506

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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