| |
14643 Mercantile Blvd, Suite 112, Hugo, MN 55038 | |
(651) 426-3630 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 14643 Mercantile Blvd, Hugo, Minnesota |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1437276763 | NPI | - | NPPES |
226680000 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 2585 (Minnesota) | Primary |
Mailing Address | Practice Location Address |
---|---|
14643 Mercantile Blvd, Suite 112, Hugo, MN 55038 Ph: (651) 426-3630 | 14643 Mercantile Blvd, Suite 112, Hugo, MN 55038 Ph: (651) 426-3630 |
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 | |