Provider Demographics
NPI:1457717803
Name:OPHTHALMOLOGY ASSOCIATES OF MANKATO
Entity Type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES OF MANKATO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:BIRKHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-345-6151
Mailing Address - Street 1:1630 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6795
Mailing Address - Country:US
Mailing Address - Phone:507-385-6151
Mailing Address - Fax:507-625-1096
Practice Address - Street 1:1630 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6795
Practice Address - Country:US
Practice Address - Phone:507-385-6151
Practice Address - Fax:507-625-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59163174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty