Provider Demographics
NPI:1043739089
Name:SO, EVA Y (OD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:Y
Last Name:SO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4276
Mailing Address - Country:US
Mailing Address - Phone:1507-288-2457
Mailing Address - Fax:507-288-2457
Practice Address - Street 1:3630 11TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4276
Practice Address - Country:US
Practice Address - Phone:507-288-2457
Practice Address - Fax:507-288-1299
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist