| |
5679 147th St N, Hugo, MN 55038-9302 | |
(651) 762-9545 | |
(651) 762-9542 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 5679 147th St N, Hugo, Minnesota |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1578778296 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 2544 (Minnesota) | Primary |
Provider Name | Michael S Petronack |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1295891596 PECOS PAC ID: 8022257633 Enrollment ID: I20130611000758 |
Mailing Address | Practice Location Address |
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5679 147th St N, Hugo, MN 55038-9302 Ph: (651) 762-9545 | 5679 147th St N, Hugo, MN 55038-9302 Ph: (651) 762-9545 |
Dr. Michael S Petronack, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 5679 147th St N, Hugo, MN 55038 Phone: 651-762-9545 Fax: 651-762-9542 | |