Individual
DR. TINA MARIE MCCARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1202 MOORE LAKE DR E, FRIDLEY, MN 55432-5170
(763) 574-0075
(763) 574-0594
Mailing address
1202 EAST MOORE LAKE DRIVE, FRIDLEY, MN 55432
(763) 574-0075
(763) 574-0594
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2837
MN
152WC0802X
Corneal and Contact Management Optometrist
Primary
2837
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293648800
—
MN
01
—
P00348012
RAILROAD MEDICARE
MN
Enumeration date
05/03/2006
Last updated
02/19/2010
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