Provider Demographics
NPI:1275560542
Name:DRS. NORTH & WATSON, OPTOMETRISTS P. A.
Entity Type:Organization
Organization Name:DRS. NORTH & WATSON, OPTOMETRISTS P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-639-0409
Mailing Address - Street 1:2480 FAIRVIEW AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2699
Mailing Address - Country:US
Mailing Address - Phone:651-639-0407
Mailing Address - Fax:651-639-2503
Practice Address - Street 1:2480 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2699
Practice Address - Country:US
Practice Address - Phone:651-639-0407
Practice Address - Fax:651-639-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO1288Medicare ID - Type UnspecifiedOFFICE NUMBER