SOUTHDALE OPTICAL CO NPI 1871576306

NPI Information

SOUTHDALE OPTICAL CO is an eyewear supplier in Edina, MN. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. SOUTHDALE OPTICAL CO NPI is 1871576306. The provider is registered as an organization entity type.

The provider's business location address is:

6533 DREW AVE S
EDINA, MN
ZIP 55435-103
Phone: (952) 925-9550
Fax: (952) 925-9748

The provider's authorized official is Bradley Jon Peterson .
The authorized official title is President and has the following contact phone number (952) 925-9550.

The enumeration date for this NPI number is 11/29/2005 and was last updated on 6/16/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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