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Organization
CORNERSTONE VISION CLINIC LLC
Active
Organization
CORNERSTONE VISION CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY ANN HANSON (OWNER)
(763) 493-3937
Entity
Organization
Contact information
Practice address
1 CENTRAL AVE W, SUITE 104, SAINT MICHAEL, MN 55376-4591
(763) 493-3937
(763) 315-3834
Mailing address
1 CENTRAL AVE W, SUITE 104, SAINT MICHAEL, MN 55376-4591
(763) 493-3937
(763) 315-3834
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2203583
MEDICA
MN
01
—
422K5CO
BCBS
MN
Enumeration date
01/03/2007
Last updated
04/21/2009
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