| NPI | 1306161187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY MEAD Practice Manager 651-735-9550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management |
| 152WP0200X Optometrist, Pediatrics | |
| 152WS0006X Optometrist, Sports Vision | |
| 152WV0400X Optometrist, Vision Therapy | |
| 156FX1202X Technician/Technologist, Optometric Technician | |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2018-04-02 |