MEDICARE: GILTHVEDT EYECARE CLINIC, INC

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	152W00000X	Optometrist	2035	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437175882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILTHVEDT EYECARE CLINIC, INC

Provider Business Mailing Address
First Line	:	2560 HARVEST LN
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-4305
Country	:	US
Telephone Number	:	507-451-3072
Fax Number	:	507-451-4291

Provider Business Practice Location Address
First Line	:	2560 HARVEST LN
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-4305
Country	:	US
Telephone Number	:	507-451-3072
Fax Number	:	507-451-4291

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TERRI NORDQUIST
Credential	:
Telephone Number	:	507-451-3072

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/17/2020

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Directions to “GILTHVEDT EYECARE CLINIC, INC ” Practice Location

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