Healthcare Provider Details

I. General information

NPI: 1396098760
Provider Name (Legal Business Name): GOLDEN RULE OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W SAINT GERMAIN ST
SAINT CLOUD MN
56301-3460
US

IV. Provider business mailing address

5782 GORRON RD
BRAINERD MN
56401-2498
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5404
  • Fax: 320-252-8938
Mailing address:
  • Phone: 320-630-1214
  • Fax: 320-252-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2873
License Number StateMN

VIII. Authorized Official

Name: DR. DANISE J MILLER
Title or Position: OWNER
Credential: OD
Phone: 320-630-1214