Provider Demographics
NPI: | 1902237258 |
---|---|
Name: | EYE U PLLC |
Entity type: | Organization |
Organization Name: | EYE U PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | WENDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SEYLLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 651-249-6537 |
Mailing Address - Street 1: | 13481 60TH ST N |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | STILLWATER |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55082-1055 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-439-6400 |
Mailing Address - Fax: | 651-439-6405 |
Practice Address - Street 1: | 13481 60TH ST N |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | STILLWATER |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55082-1055 |
Practice Address - Country: | US |
Practice Address - Phone: | 651-439-6400 |
Practice Address - Fax: | 651-439-6405 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-12-11 |
Last Update Date: | 2013-12-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 2105 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |