| NPI | 1316955941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETT FREDRICKSON Practice Administrator 218-759-1430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2110) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2022-05-02 |