| Pequot Eye Center | |
|
4461 Main St,, Pequot Lakes, MN 56472 | |
| (218) 568-5555 | |
| (218) 568-8904 |
| Full Name | Pequot Eye Center |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 4461 Main St,, Pequot Lakes, Minnesota |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396918884 | NPI | - | NPPES |
| 64756PE | Other | MN | BLUE CROSS/ BLUE SHIELD |
| 2220699 | Other | MN | MEDICA |
| 050325800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 2316 (Minnesota) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Pequot Eye Center Po Box 176, Pequot Lakes, MN 56472-0176 Ph: (218) 568-5555 | Pequot Eye Center 4461 Main St,, Pequot Lakes, MN 56472 Ph: (218) 568-5555 |
Dr. Todd M Wiedell, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 30960 Government Dr, Pequot Lakes, MN 56472 Phone: 218-568-5555 Fax: 218-568-8904 | |
Crosslake Eye Center Optometrist Medicare: Medicare Enrolled Practice Location: 30960 Government Dr, Pequot Lakes, MN 56472 Phone: 218-568-5555 Fax: 218-568-8904 |