| NPI | 1982028312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA MABIE President 651-702-2504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2593) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: MN 096034) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-05 |