Provider Demographics
NPI:1588030787
Name:841 OPTOMETRY PC
Entity Type:Organization
Organization Name:841 OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-887-6631
Mailing Address - Street 1:5817 IVY LN
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5314
Mailing Address - Country:US
Mailing Address - Phone:303-887-6631
Mailing Address - Fax:
Practice Address - Street 1:5817 IVY LN
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5314
Practice Address - Country:US
Practice Address - Phone:303-887-6631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty