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General NPI Number Information
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NPI Number | 1083935068
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Entity Type | Individual
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Provider Name | GEORGE RANDALL WANDLING JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 3777 COON RAPIDS BLVD NW # 100
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City | COON RAPIDS
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State | MN
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Zip | 55433-2630
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Country | US
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Telephone | 763-421-7420
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Fax |
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Provider Business Mailing Address
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Address Line | 3777 COON RAPIDS BLVD NW # 100
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City | COON RAPIDS
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State | MN
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Zip | 55433-2630
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Country | US
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Telephone | 763-421-7420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 41882
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036137863
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 59282
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License Number State | MN
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