Healthcare Provider Details

I. General information

NPI: 1447073796
Provider Name (Legal Business Name): HUNTER RILEY THRONDSEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 TROOP DR
SARTELL MN
56377-4582
US

IV. Provider business mailing address

2180 TROOP DR
SARTELL MN
56377-4582
US

V. Phone/Fax

Practice location:
  • Phone: 320-258-3915
  • Fax:
Mailing address:
  • Phone: 320-258-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3964
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: