| |
210 2nd Ave N, Sauk Rapids, MN 56379-1608 | |
(320) 257-4990 | |
(320) 257-4991 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 210 2nd Ave N, Sauk Rapids, Minnesota |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1275772790 | NPI | - | NPPES |
428318000 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | LD22510000 (Minnesota) | Primary |
Provider Name | Thomas N Johnson |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1831290550 PECOS PAC ID: 4082693452 Enrollment ID: I20040719000704 |
Mailing Address | Practice Location Address |
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210 2nd Ave N, Sauk Rapids, MN 56379-1608 Ph: (320) 257-4990 | 210 2nd Ave N, Sauk Rapids, MN 56379-1608 Ph: (320) 257-4990 |
Kayleen Dempsey, Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1311 2nd St N Ste 105, Sauk Rapids, MN 56379 Phone: 320-774-3666 Fax: 320-774-3660 |