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NPI Code Detail

MEDICARE: DR. FRANK CLARK MUNNS O.D.

MEDICARE:  DR. FRANK CLARK MUNNS  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristLD1918000MN
2152W00000XOptometrist1407-035WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
147521DUOTHERWIBC/BS CCS CLINIC NUM.
22288846OTHERMNMEDICA PROVIDER NUM.
326781MUOTHERMNBC/BS CCS CLINIC NUM.
437B31MUOTHERWIBC/BS CCS PROVIDER NUM.
5IG464MUOTHERMNBC/BS CCS PROVIDER NUM.

General Provider Information

NPI Number : 1124023213
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRANK CLARK MUNNS O.D.
Provider Business Mailing Address
First Line : 6632 BERGSTROM RD
Second Line :
City : DULUTH
State : MN
Zip : 55803-9236
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 MILLER TRUNK HWY
Second Line :
City : DULUTH
State : MN
Zip : 55811-5640
Country : US
Telephone Number : 218-725-0204
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/21/2022

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Directions to “ DR. FRANK CLARK MUNNS O.D.” Practice Location

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