Provider Demographics
NPI:1730119918
Name:DRS. NORTH & WATSON, OPTOMETRISTS P. A.
Entity Type:Organization
Organization Name:DRS. NORTH & WATSON, OPTOMETRISTS P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-639-0409
Mailing Address - Street 1:12511 WAYZATA BLVD
Mailing Address - Street 2:RIDGEDALE CENTER
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1938
Mailing Address - Country:US
Mailing Address - Phone:952-591-1970
Mailing Address - Fax:952-591-1972
Practice Address - Street 1:12511 WAYZATA BLVD
Practice Address - Street 2:RIDGEDALE CENTER
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1938
Practice Address - Country:US
Practice Address - Phone:952-591-1970
Practice Address - Fax:952-591-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01420Medicare PIN