Provider Demographics
NPI:1518192798
Name:FAMILY EYECARE PA
Entity Type:Organization
Organization Name:FAMILY EYECARE PA
Other - Org Name:EYEDEALS EYECARE PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:612-819-3475
Mailing Address - Street 1:PO BOX 8007
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-0007
Mailing Address - Country:US
Mailing Address - Phone:651-644-5102
Mailing Address - Fax:
Practice Address - Street 1:2309 COMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1723
Practice Address - Country:US
Practice Address - Phone:651-644-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05840Medicare PIN