| NPI | 1558723411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE LORRAINE NELSON Insurance Biller 651-457-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN MN1944) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2018-02-01 |