Organization
ST CLOUD EYE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEFOREST EVERTON STARKEY III (OFFICE MANAGER)
(320) 251-1432
Entity
Organization
Contact information
Practice address
2055 15TH ST N, SAINT CLOUD, MN 56303-1747
(320) 251-1432
(320) 251-7122
Mailing address
2055 15TH ST N, SAINT CLOUD, MN 56303-1747
(320) 251-1432
(320) 251-7122
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221523300
—
MN
01
—
54575LA
BLUE CROSS
MN
01
—
C01527
RAILROAD MEDICARE
—
Enumeration date
10/11/2005
Last updated
01/28/2013
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