Provider Demographics
NPI:1326170895
Name:OSBORNE, PATRICIA LOUISE
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 VINCENT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3318
Mailing Address - Country:US
Mailing Address - Phone:612-287-9625
Mailing Address - Fax:612-287-9625
Practice Address - Street 1:3989 CENTRAL AVE NE
Practice Address - Street 2:SUITE 200F
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3900
Practice Address - Country:US
Practice Address - Phone:651-331-0617
Practice Address - Fax:612-287-9625
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA149254156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician