| NPI | 1083885081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE JEAN JACOBS Administrator 952-835-0965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2013-01-04 |