| NPI | 1609921899 |
|---|---|
| Doing Business As | BIRCH LAKE EYE CLINIC, OAK TREE OPTICAL, VILLAGE EYE CLINIC AND OPTICA |
| Entity Type | Organization |
| Authorized Contact | BRIAN DWIGHT GRUDEM CFO 651-426-2747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN LD1732000) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN LD2695000) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2009-12-02 |