Organization
FIFTH AVENUE OF EDINA INC.
Active
Other names
FIFTH AVENUE OPTICAL
Organization subpart
No
Provider details
NPI number
Authorized official
GALE L STEAD O.D. (OWNER)
(952) 922-1052
Entity
Organization
Contact information
Practice address
3540 GALLERIA, EDINA, MN 55435-4218
(952) 922-1052
(952) 922-2518
Mailing address
3540 GALLERIA, EDINA, MN 55435-4218
(952) 922-1052
(952) 922-2518
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1456
MN
332H00000X
Eyewear Supplier
Primary
1456
MN
Other
Enumeration date
11/26/2008
Last updated
06/13/2012
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