MEDICARE: ST PAUL EYE CLINIC PA

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	:	1629170469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST PAUL EYE CLINIC PA

Provider Business Mailing Address
First Line	:	2080 WOODWINDS DR
Second Line	:	SUITE 110
City	:	WOODBURY
State	:	MN
Zip	:	55125-2524
Country	:	US
Telephone Number	:	651-738-6800
Fax Number	:	651-714-6997

Provider Business Practice Location Address
First Line	:	1093 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3002
Country	:	US
Telephone Number	:	651-222-7343
Fax Number	:	651-228-9398

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS J. RICE
Credential	:	M.D.
Telephone Number	:	651-738-6800

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	04/12/2012

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