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General NPI Number Information
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NPI Number | 1841577418
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Entity Type | Organization
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Legal Business Name | COMPLETE EYECARE P L C
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 260 NORTHTOWN DR NE
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City | BLAINE
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State | MN
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Zip | 55434-1037
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Country | US
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Telephone | 763-784-9049
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Fax |
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Provider Business Mailing Address
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Address Line | 260 NORTHTOWN DR NE
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City | BLAINE
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State | MN
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Zip | 55434-1037
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Country | US
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Telephone | 763-784-9049
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | CHAD KRIETLOW
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Credential | OD
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Telephone | 763-784-9049
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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 | 2821
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License Number State | MN
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