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General NPI Number Information
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NPI Number | 1770674160
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Entity Type | Individual
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Provider Name | ALLISON LYNN WIEDEMANN OD
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 570 NORTHTOWN DR NE
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City | BLAINE
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State | MN
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Zip | 55434-1043
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Country | US
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Telephone | 763-784-4081
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Fax | 866-822-2088
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Provider Business Mailing Address
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Address Line | 570 NORTHTOWN DR NE
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City | BLAINE
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State | MN
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Zip | 55434-1043
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Country | US
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Telephone | 763-784-4081
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Fax | 866-822-2088
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002322
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3164
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License Number State | MN
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