Provider Demographics
NPI:1134682669
Name:ROSEVILLE EYE ASSOCIATES P.A.
Entity Type:Organization
Organization Name:ROSEVILLE EYE ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-513-0092
Mailing Address - Street 1:1790 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6167
Mailing Address - Country:US
Mailing Address - Phone:651-488-6771
Mailing Address - Fax:
Practice Address - Street 1:3601 PARK CENTER BLVD APT 607
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2562
Practice Address - Country:US
Practice Address - Phone:608-513-0092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center