Healthcare Provider Details

I. General information

NPI: 1942399456
Provider Name (Legal Business Name): VICKI SUE LUEHMANN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICKI SUE BOROWICZ O.D.

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 1ST ST E SUITE 101
JORDAN MN
55352-1561
US

IV. Provider business mailing address

223 1ST ST E SUITE 101
JORDAN MN
55352-1561
US

V. Phone/Fax

Practice location:
  • Phone: 952-492-2350
  • Fax: 952-492-6162
Mailing address:
  • Phone: 952-492-2350
  • Fax: 952-492-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2848000
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2848000
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2848000
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number2848000
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number2848000
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: