Healthcare Provider Details

I. General information

NPI: 1619484078
Provider Name (Legal Business Name): THRIVE WITH VISION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E BROADWAY
LITTLE FALLS MN
56345-3039
US

IV. Provider business mailing address

118 E BROADWAY
LITTLE FALLS MN
56345-3039
US

V. Phone/Fax

Practice location:
  • Phone: 320-632-1950
  • Fax:
Mailing address:
  • Phone: 320-632-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2873
License Number StateMN

VIII. Authorized Official

Name: DR. DANISE JOANN MILLER
Title or Position: OWNER OPTOMETRIST
Credential: OD
Phone: 320-632-1950