Individual
MEGAN MARIE SIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD, MS, FAAO
Contact information
Practice address
12170 ABERDEEN ST NE, BLAINE, MN 55449-4716
(763) 757-7000
(763) 757-3328
Mailing address
12170 ABERDEEN ST NE, BLAINE, MN 55449-4716
(763) 757-7000
(763) 757-3328
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3315
MN
152W00000X
Optometrist
OEG002668
PA
152WV0400X
Vision Therapy Optometrist
3315
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3315
LICENSE
MN
01
—
OEG002668
LICENSE
PA
Enumeration date
10/07/2009
Last updated
07/11/2019
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