Organization
BRADLEY W NEUJAHR OD PA
Active
Other names
Northwest Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY WAYNE NEUJAHR OD (CEO OWNER)
(218) 435-1010
Entity
Organization
Contact information
Practice address
111 2ND ST NE, FOSSTON, MN 56542-1301
(218) 435-1010
(218) 435-1715
Mailing address
111 2ND ST NE, FOSSTON, MN 56542-1301
(218) 435-1010
(218) 435-1715
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1892
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050601001
METROPOLITAN HEALTH PLAN
—
01
—
116599
MEDICARE - U CARE
MN
05
—
116599
—
MN
05
—
137823600
—
MN
01
—
22 24063
MEDICA
—
01
—
410004074
RR MEDICARE
—
01
—
63235NE
BCBS OF MN FACILITY
—
01
—
63309FO
BCBS BLUE PLUS MATERIALS
—
01
—
63585NE
BCBS OF MN INDIVIDUAL DR
—
01
—
982601006692
PREFERRED ONE
—
Enumeration date
10/11/2005
Last updated
10/28/2008
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