Provider Demographics
NPI:1437393022
Name:NEXT GENERATION OPHTHALMICS
Entity Type:Organization
Organization Name:NEXT GENERATION OPHTHALMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HONSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-327-2535
Mailing Address - Street 1:1200 SE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4294
Mailing Address - Country:US
Mailing Address - Phone:218-327-2535
Mailing Address - Fax:218-327-4933
Practice Address - Street 1:1200 SE 4TH AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4294
Practice Address - Country:US
Practice Address - Phone:218-327-2535
Practice Address - Fax:218-327-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier