| NPI | 1427563386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORI DODGE Clinic Administrator 952-925-4161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: MN 33370) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2019-06-11 |