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NPI Code Detail

MEDICARE: FARSTAD INC DBA PEARLE VISION

MEDICARE: FARSTAD INC DBA PEARLE VISION
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
1152W00000XOptometrist2926MN

General Provider Information

NPI Number : 1922215177
Entity Type Code : Organization
Provider Name (Legal Business Name) : FARSTAD INC DBA PEARLE VISION
Provider Business Mailing Address
First Line : 2034 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1931
Country : US
Telephone Number : 651-698-2744
Fax Number : 651-698-6918
Provider Business Practice Location Address
First Line : 2034 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1931
Country : US
Telephone Number : 651-698-2744
Fax Number : 651-698-6918
Authorized Official
Title or Position : MANAGER
Name : BECKY KERKOW
Credential :
Telephone Number : 651-698-2744
Provider Enumeration Date : 05/17/2007
Last Update Date : 08/22/2020

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