MEDICARE: DJ-MN 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	156FX1800X	Optician

General Provider Information

NPI Number	:	1720139579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DJ-MN INC

Provider Business Mailing Address
First Line	:	1920 1ST AVE
Second Line	:
City	:	ANOKA
State	:	MN
Zip	:	55303-2437
Country	:	US
Telephone Number	:	763-427-4000
Fax Number	:

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	:	763-427-4000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANE THELEN
Credential	:
Telephone Number	:	763-427-4000

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	02/29/2008

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Directions to “DJ-MN INC ” Practice Location

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