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: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13195 WEAVER LAKE RD
MAPLE GROVE MN
55369-9410
US

IV. Provider business mailing address

13195 WEAVER LAKE RD
MAPLE GROVE MN
55369-9410
US

V. Phone/Fax

Practice location:
  • Phone: 763-420-5112
  • Fax: 763-420-6957
Mailing address:
  • Phone: 763-420-5112
  • Fax: 763-420-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2848
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2848
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number2848
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number2848
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2848
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: