| NPI | 1518059526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS MATTHEW JOHNSON President 651-439-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN LD2763000) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MN LD2763000) |
| 152WP0200X Optometrist Pediatrics (Licence: LD2763000) | |
| 152WV0400X Optometrist Vision Therapy (Licence: MN LD2763000) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2012-08-16 |