MEDICARE: DAVID THELEN

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
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1407927734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID THELEN

Provider Business Mailing Address
First Line	:	204 LEWIS AVE S
Second Line	:	SUITE 102
City	:	WATERTOWN
State	:	MN
Zip	:	55388-4500
Country	:	US
Telephone Number	:	952-955-3553
Fax Number	:	952-955-1900

Provider Business Practice Location Address
First Line	:	204 LEWIS AVE S
Second Line	:	SUITE 102
City	:	WATERTOWN
State	:	MN
Zip	:	55388-4500
Country	:	US
Telephone Number	:	952-955-3553
Fax Number	:	952-955-1900

Authorized Official
Title or Position	:	OWNER
Name	:	JANE THELEN
Credential	:
Telephone Number	:	763-295-4044

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1790768364 — WILLIAM CURTIS WHISLER MD
Practice Location Address:

204 LEWIS AVE S , SUITE 200
WATERTOWN, MN
55388-4500

Practice Phone: 952-955-1963
Practice Fax: 952-955-1965

1124002548 — KRISTIN J OLSON CFNP
Practice Location Address:

204 LEWIS AVE S , SUITE 200
WATERTOWN, MN
55388-4500

Practice Phone: 952-955-1963
Practice Fax: 952-955-1965

1720013279 — WATERTOWN PHARMACY LLC
Practice Location Address:

204 LEWIS AVE S , SUITE 101
WATERTOWN, MN
55388-4500

Practice Phone: 952-955-2153
Practice Fax:

1396770830 — ROSEMARY LOUISE ROSDAHL RPH
Practice Location Address:

204 LEWIS AVE S , SUITE 101
WATERTOWN, MN
55388-4500

Practice Phone: 952-955-2153
Practice Fax:

1811091176 — MRS. TONYA KAY SCHRADER MS CCC SLP
Practice Location Address:

204 LEWIS AVE S , SUITE 104
WATERTOWN, MN
55388-4500

Practice Phone: 952-955-3323
Practice Fax: 952-255-8075

1720139579 — DJ-MN INC
Practice Location Address:

204 LEWIS AVE S , SUITE 102
WATERTOWN, MN
55388-4500

Practice Phone: 763-427-4000
Practice Fax:

Directions to “DAVID THELEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.