Basic Information
| Provider Information | |||||||||
| NPI: | 1396814539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWAY EYE & CONTACT LENS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1545 NORTHWAY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563031940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202532441 | ||||||||
| FaxNumber: | 3202532446 | ||||||||
| Practice Location | |||||||||
| Address1: | 1545 NORTHWAY DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563031940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202532441 | ||||||||
| FaxNumber: | 3202532446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUGGENBERGER | ||||||||
| AuthorizedOfficialFirstName: | NATALIE | ||||||||
| AuthorizedOfficialMiddleName: | MARY | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3202532441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1776 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 2751 | MN | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 2909 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.