Provider Demographics
NPI:1275725277
Name:FAMILY VISION CLINIC OF FARMINGTON
Entity Type:Organization
Organization Name:FAMILY VISION CLINIC OF FARMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-895-5434
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-0252
Mailing Address - Country:US
Mailing Address - Phone:952-895-5434
Mailing Address - Fax:952-895-5464
Practice Address - Street 1:19650 PILOT KNOB ROAD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024
Practice Address - Country:US
Practice Address - Phone:952-895-5434
Practice Address - Fax:952-895-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty