| NPI | 1265733471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON JEDLICKA Owner 952-641-6226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LD2631) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 44481) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2011-03-21 |