Provider Demographics
NPI:1437251287
Name:ST PAUL EYE CLINIC PA
Entity Type:Organization
Organization Name:ST PAUL EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-738-6800
Mailing Address - Street 1:2080 WOODWINDS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2524
Mailing Address - Country:US
Mailing Address - Phone:651-738-6800
Mailing Address - Fax:651-714-6997
Practice Address - Street 1:1675 BEAM AVE
Practice Address - Street 2:STE 100
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109
Practice Address - Country:US
Practice Address - Phone:651-770-2904
Practice Address - Fax:651-770-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1269030005Medicare NSC