| NPI | 1114921996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MADISON Administrator 952-848-8312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 0026007) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MN 0026007) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2022-10-11 |