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General NPI Number Information
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NPI Number | 1194014910
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Entity Type | Organization
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Legal Business Name | COTTRELL,LLOYD OPTOMETRIC,PA
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 295 TYLER RD S
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City | RED WING
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State | MN
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Zip | 55066-1736
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Country | US
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Telephone | 651-385-0886
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Fax |
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Provider Business Mailing Address
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Address Line | 2404 VIKING DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL M COTTRELL
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Credential |
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Telephone | 507-951-0144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2396
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License Number State | MN
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