Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 2216006 | MN |
NPI | 1134309966 |
---|---|
Provider Name | Mr. August Michael Eiynck |
First Address | Minneapolis, MN 55402-2606 |
Second Address | Minneapolis, MN 55402-2606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2007 |
Last Update Date | 08/11/2007 |