Provider Demographics
NPI:1740210913
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 1:2070 BURNSVILLE CTR # 72
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4438
Mailing Address - Country:US
Mailing Address - Phone:952-435-3686
Mailing Address - Fax:952-435-3074
Practice Address - Street 1:2070 BURNSVILLE CTR # 72
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4438
Practice Address - Country:US
Practice Address - Phone:952-435-3686
Practice Address - Fax:952-435-3074
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
MNC01382Medicare PIN