NPI 1003922030

Roy William Backus, OD

Practitioner Optometrist Forest Lake, MN

Practice location

Address: 200 12th St SW, Forest Lake, MN 55025-1482
Phone: (651) 464-9767
Fax: (651) 464-9062
Mailing address: 38050 Jeffery Ave, North Branch, MN 55056-5908

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 2520 (MN)

Other Optometrist providers in Minnesota →

Registry record

NPI: 1003922030
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Aug 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.