Provider Demographics
NPI:1801892237
Name:OPHTHALMOLOGY ASSOCIATES OF MANKATO PA
Entity type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES OF MANKATO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMICH
Authorized Official - Suffix:
Authorized Official - Credentials:
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:56001-4801
Mailing Address - Country:US
Mailing Address - Phone:507-345-6151
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
Practice Address - Country:US
Practice Address - Phone:507-345-6151
Practice Address - Fax:507-625-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND48658207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN590312200Medicaid