| NPI | 1932173374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT L WILDE President 952-567-6143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management |
| 332H00000X Eyewear Supplier (Equipment, not the service) | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2017-02-22 |