| NPI | 1184715104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL MAYNE Business Office Manager 952-832-8143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 7314104) |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-02-06 |