Provider Demographics
NPI:1285298240
Name:BREEN, ANN LOUISE
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:BREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-0606
Mailing Address - Country:US
Mailing Address - Phone:701-430-9898
Mailing Address - Fax:
Practice Address - Street 1:SANFORD SOUTHPOINTE EYE CENTER & OPTICAL
Practice Address - Street 2:2400 32ND AVE. S.
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-234-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3619152W00000X
390200000X
ND763152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program