| NPI | 1730319021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ROBIN MATHISEN O PT Ometrist 763-229-2235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WP0200X Optometrist Pediatrics (Licence: WY 223T) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-08-05 |