Backus, Roy William

Backus, Roy William is an individual health care provider with primary practice located at 200 12Th St Sw , Forest Lake MN 55025-1482. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Backus, Roy William can be contacted via phone (651) 464-9767.

Contact Information

Primary practice address
200 12Th St Sw Forest Lake MN 55025-1482
Phone: (651) 464-9767
Fax: (651) 464-9062
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2520 Minnesota

Profile Details

NPI number 1003922030
LBN Legal business name Backus, Roy William
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003922030 NPPES
Minnesota Other 22-14902 MEDICA
Minnesota Other 48705 MEDICA
Minnesota MEDICAID 4100006627 MEDICA
Minnesota Other 6C258BA MEDICA
Minnesota Other 152144 MEDICA
Minnesota Other 410042867 MEDICA
Minnesota Other 212298 MEDICA
Minnesota Other 12060 MEDICA
Minnesota Other 489437500 MEDICA
Minnesota Other 71-0415188 MEDICA

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