Provider Demographics
NPI:1780023879
Name:SIRIUS VISION OPTICAL INC
Entity Type:Organization
Organization Name:SIRIUS VISION OPTICAL INC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-435-8821
Mailing Address - Street 1:1056 BURNSVILLE CTR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4408
Mailing Address - Country:US
Mailing Address - Phone:952-435-8821
Mailing Address - Fax:952-435-1624
Practice Address - Street 1:1056 BURNSVILLE CTR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4408
Practice Address - Country:US
Practice Address - Phone:952-435-8821
Practice Address - Fax:952-435-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty