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Organization
DJ-MN, INC
Active
Organization
DJ-MN, INC
Active
Other names
Innovative Eyewear
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANE M THELEN (OWNER)
(763) 427-4000
Entity
Organization
Contact information
Practice address
1700 HIGHWAY 25 N, BUFFALO, MN 55313-1930
(763) 684-0025
(763) 684-0847
Mailing address
1700 HIGHWAY 25 N, BUFFALO, MN 55313-1930
(763) 684-0025
(763) 684-0847
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14B51IN
BLUECROSSBLUESHIELD
MN
01
—
21-00484
MEDICA
MN
05
—
454103200
—
MN
Enumeration date
12/07/2007
Last updated
06/09/2014
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