Healthcare Provider Details

I. General information

NPI: 1871543884
Provider Name (Legal Business Name): VISION CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 4TH ST NE
STAPLES MN
56479-2428
US

IV. Provider business mailing address

222 4TH ST NE
STAPLES MN
56479-2428
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1331
  • Fax: 218-895-1332
Mailing address:
  • Phone: 218-894-1331
  • Fax: 218-895-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LAMAR WAYNE GUNNARSON
Title or Position: OWNER
Credential: OD
Phone: 218-894-1331