Provider Demographics
NPI:1790805976
Name:APEX OPTOMETRY RESOURCES LLC
Entity Type:Organization
Organization Name:APEX OPTOMETRY RESOURCES LLC
Other - Org Name:GRAF OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MBA
Authorized Official - Phone:651-631-8112
Mailing Address - Street 1:2990 SHERRY CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4639
Mailing Address - Country:US
Mailing Address - Phone:602-326-2189
Mailing Address - Fax:651-631-8112
Practice Address - Street 1:1605 COUNTY ROAD C W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1302
Practice Address - Country:US
Practice Address - Phone:651-631-8112
Practice Address - Fax:651-631-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD2845152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO3717Medicare ID - Type Unspecified
MNU97894Medicare UPIN