| Organization Name: | ST ANTHONY OPTOMETRIC CLINIC |
| NPI Number: | 1205953437 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TODD JEFFREY HANSON (PRESIDENT OWNER) |
| Mailing Address: | 2929 Pentagon Dr St Anthony |
| State: | MN US |
| Postal Code: | 554183208 |
| Phone Number: | 6127814730 |
| Fax Number: | 6127062337 |
| NPI Enumeration Date: | 03/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 2443 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |