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Individual

DR. ROY WILLIAM BACKUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
200 12TH ST SW, FOREST LAKE, MN 55025-1482
(651) 464-9767
(651) 464-9062
Mailing address
38050 JEFFERY AVE, NORTH BRANCH, MN 55056-5908
(651) 237-0330

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2520
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12060
SPECTERA
MN
01
152144
COLE VISION
MN
01
212298
BCBS OPTI CHOICE #
MN
01
22-14902
MEDICA
MN
05
4100006627
MN
01
410042867
RAILROAD PROVIDER #
MN
01
48705
DAVIS VISION
MN
01
489437500
MN HEALTH CARE PROVIDER #
MN
01
6C258BA
BCBS
MN
01
71-0415188
SUPERIOR VISION
MN
Enumeration date
08/22/2006
Last updated
07/08/2007
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