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General NPI Number Information
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NPI Number | 1336235449
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Entity Type | Organization
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Legal Business Name | THOMAS N LORENTZSEN & STANTON L ANDRIST PTR
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 420 CENTER AVE SUITE 41
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City | MOORHEAD
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State | MN
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Zip | 56560
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Country | US
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Telephone | 218-233-1624
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Fax | 218-233-2058
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Provider Business Mailing Address
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Address Line | 420 CENTER AVE SUITE 41
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City | MOORHEAD
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State | MN
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Zip | 56560
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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 | CLAIMS SUPERVISOR
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Name | LYNN M IVERSON
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Credential |
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Telephone | 218-233-1624
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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 |
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License Number State |
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