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General NPI Number Information
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NPI Number | 1659407377
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Entity Type | Organization
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Legal Business Name | JUETTNER OPTICAL INC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1145 LARPENTEUR AVE W
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City | ROSEVILLE
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State | MN
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Zip | 55113-6335
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Country | US
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Telephone | 651-487-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 LARPENTEUR AVE W
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City | ROSEVILLE
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State | MN
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Zip | 55113-6335
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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 | OWNER
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Name | JOSEPH JUETTNER
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Credential |
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Telephone | 651-487-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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