Provider Demographics
NPI:1639115546
Name:RELF OPTICAL LTD
Entity Type:Organization
Organization Name:RELF OPTICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RELF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-720-3553
Mailing Address - Street 1:5007 MATTERHORN DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3812
Mailing Address - Country:US
Mailing Address - Phone:218-720-3553
Mailing Address - Fax:218-786-9375
Practice Address - Street 1:5007 MATTERHORN DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3812
Practice Address - Country:US
Practice Address - Phone:218-720-3553
Practice Address - Fax:218-786-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4438930001Medicare ID - Type Unspecified
MN4438930001Medicare NSC