Organization
CEDAR LAKES EYE SPECIALISTS PA
Active
Other names
DBA: Origins Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BANE OD (OWNER)
(763) 582-9601
Entity
Organization
Contact information
Practice address
5801 W 16TH ST, ST LOUIS PARK, MN 55416-1446
(763) 582-9601
(763) 582-9613
Mailing address
PO BOX 1170, MAPLE GROVE, MN 55311-6170
(763) 582-9601
(763) 582-9613
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3009
MN
Other
Enumeration date
05/26/2011
Last updated
04/30/2018
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