| Family Eyecare Pa | |
|
2309 Como Ave Saint Paul MN 55108-1723 | |
| (651) 644-5102 | |
| Not Available |
| Full Name | Family Eyecare Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 2309 Como Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | David M Daly (PRESIDENT) |
| Authorized Official Contact | 6128193475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Eyecare Pa Po Box 8007 Saint Paul MN 55108-0007 Ph: (651) 644-5102 | Family Eyecare Pa 2309 Como Ave Saint Paul MN 55108-1723 Ph: (651) 644-5102 |
| NPI Number | 1518192798 |
|---|---|
| Provider Enumeration Date | 05/18/2009 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1557548856 |
|---|---|
| Medicare Enrollment ID | O20110615000069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518192798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Minnesota) | Primary |
| Provider Name | David M Daly |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1477632065 PECOS PAC ID: 4183801483 Enrollment ID: I20110615000089 |
| Provider Name | Joel Dennis Peterson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902459530 PECOS PAC ID: 4082941976 Enrollment ID: I20190815001664 |
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