| |
7880 Mainstreet, Maple Grove, MN 55369-7081 | |
(763) 420-6981 | |
(763) 773-7253 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 7880 Mainstreet, Maple Grove, Minnesota |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1659556264 | NPI | - | NPPES |
652323400 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1457 (Minnesota) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
7880 Main St N, Maple Grove, MN 55369-7081 Ph: (763) 420-6981 | 7880 Mainstreet, Maple Grove, MN 55369-7081 Ph: (763) 420-6981 |