| NPI | 1104146265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT L WILDE President 952-567-6143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 31920) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2017-02-22 |