NPI | 1821243239 |
---|---|
Other Name | FIFTH AVENUE OPTICAL |
Entity Type | Organization |
Authorized Contact | GALE L STEAD Owner 952-922-1052 |
Organization Subpart ? | No |
Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MN 1456) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MN 1456) |
Enumeration Date | 2008-11-26 |
Last Update Date | 2012-06-13 |