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NPI Code Detail

MEDICARE: LANDON MICHAEL KUDRNA O.D.

MEDICARE: LANDON MICHAEL KUDRNA O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3746MN

General Provider Information

NPI Number : 1285206318
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANDON MICHAEL KUDRNA O.D.
Provider Business Mailing Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 763-757-7000
Fax Number : 763-757-3328
Provider Business Practice Location Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 637-577-0007
Fax Number : 763-757-3328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2021
Last Update Date : 07/16/2021

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