| River Lake Clinic | |
|
4323 E Lake St Minneapolis MN 55406-2307 | |
| (612) 722-1003 | |
| (612) 721-6336 |
| Full Name | River Lake Clinic |
|---|---|
| Speciality | Optometrist |
| Location | 4323 E Lake St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Michel E. Hanen-smith (MEMBER) |
| Authorized Official Contact | 6127221003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River Lake Clinic 4323 E Lake St Minneapolis MN 55406-2307 Ph: (612) 722-1003 | River Lake Clinic 4323 E Lake St Minneapolis MN 55406-2307 Ph: (612) 722-1003 |
| NPI Number | 1902932965 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 01/30/2014 |
| Medicare PECOS PAC ID | 3173749322 |
|---|---|
| Medicare Enrollment ID | O20140723001701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902932965 | NPI | - | NPPES |
| Provider Name | Michel E Hanen-smith |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1326119223 PECOS PAC ID: 4981659885 Enrollment ID: I20050314000703 |
| Provider Name | Sandra S Smith-hanen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750480679 PECOS PAC ID: 8820037229 Enrollment ID: I20050426000501 |
| Provider Name | Joshua Jessie Dewar Smith Hanen |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1407293061 PECOS PAC ID: 5395984769 Enrollment ID: I20130614000305 |
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