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General NPI Number Information
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NPI Number | 1962496570
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Entity Type | Organization
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Legal Business Name | RICHARD N KITTELSON
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 918 WASHINGTON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3402
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Country | US
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Telephone | 218-847-8021
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Fax | 218-846-9552
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Provider Business Mailing Address
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Address Line | 918 WASHINGTON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3402
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Country | US
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Telephone | 218-847-8021
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Fax | 218-846-9552
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | MR. RICHARD N KITTELSON
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Credential | ABOC
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Telephone | 218-847-8021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 03590
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License Number State | MN
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