| NPI | 1477961019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY ANN SJOBERG Sole Proprietor 218-546-5108 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 152WC0802X Optometrist Corneal and Contact Management | |
| 152WL0500X Optometrist Low Vision Rehabilitation | |
| 152WP0200X Optometrist Pediatrics | |
| 152WS0006X Optometrist Sports Vision | |
| 152WV0400X Optometrist Vision Therapy | |
| 152WX0102X Optometrist Occupational Vision | |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2015-03-16 |