| NPI | 1730472523 |
|---|---|
| Doing Business As | DBA: ORIGINS EYE CLINIC |
| Entity Type | Organization |
| Authorized Contact | DAVID BANE Owner 763-582-9601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3009) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2018-04-30 |