| NPI | 1902932965 |
|---|---|
| Doing Business As | RIVER LAKE CLINIC |
| Entity Type | Organization |
| Authorized Contact | MICHEL E. HANEN-SMITH Member 612-722-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 1652) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: MN 1652) |
| 152WV0400X Optometrist, Vision Therapy (Licence: MN 1652) | |
| 152W00000X Optometrist (Licence: MN 3331) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MN 3331) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MN 3331) | |
| 152WP0200X Optometrist, Pediatrics (Licence: MN 3331) | |
| 152WS0006X Optometrist, Sports Vision (Licence: MN 3331) | |
| 103T00000X Psychologist (Licence: MN LP2754) | |
| 103TF0000X Psychologist, Family (Licence: MN LP2754) | |
| 103TC1900X Psychologist, Counseling (Licence: MN LP2754) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MN LP2754) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MN LP2754) | |
| 103TF0200X Psychologist, Forensic (Licence: MN LP2754) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-01-30 |