| NPI | 1780742270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI LYNN STONE Bookkeeper Owner 218-283-4788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 1583) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MN 1583) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-06-05 |