Healthcare Provider Details

I. General information

NPI: 1104951722
Provider Name (Legal Business Name): FRANK C. MUNNS O.D. L.T.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MILLER TRUNK HWY
DULUTH MN
55811-5640
US

IV. Provider business mailing address

6632 BERGSTROM RD
DULUTH MN
55803-9236
US

V. Phone/Fax

Practice location:
  • Phone: 218-725-0204
  • Fax: 218-722-8873
Mailing address:
  • Phone: 218-727-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberLD1918000
License Number StateMN

VIII. Authorized Official

Name: DR. FRANK CLARK MUNNS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 218-727-3835