Organization
PROGRESSIVE EYE CARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA L KENT (PRACTICE ADMINISTRATOR)
(651) 645-3997
Entity
Organization
Contact information
Practice address
1690 UNIVERSITY AVENUE W, #140, ST PAUL, MN 55104
(651) 645-3997
(651) 641-7207
Mailing address
1690 UNIVERSITY AVENUE W, #140, ST PAUL, MN 55104
(651) 645-3997
(651) 641-7207
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
776
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0461340002
DMERC
—
05
—
823212100
—
MN
01
—
CS0820
RAILROAD MEDICARE
—
Enumeration date
04/13/2007
Last updated
06/24/2010
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