| NPI | 1316107790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY LEON ANDERSON Optometrist 507-282-7121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2665) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MN 2665) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2009-04-01 |