| |
318 Jefferson St S Ste 1, Wadena, MN 56482-1556 | |
(218) 631-3300 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 318 Jefferson St S Ste 1, Wadena, Minnesota |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1487398384 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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Po Box 19060, Green Bay, WI 54307-9060 Ph: (920) 429-7285 | 318 Jefferson St S Ste 1, Wadena, MN 56482-1556 Ph: (218) 631-3300 |