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Organization

TLC OF THE TWIN CITIES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TRACY LYNN CHRISTENSEN (CEO)
(763) 420-4026
Entity
Organization

Contact information

Practice address
11330 FOUNTAINS DR, MAPLE GROVE, MN 55369-7200
(763) 494-8061
Mailing address
16555 77TH CIR N, MAPLE GROVE, MN 55311-3734
(763) 420-4026

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2527
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2202630
MEDICA
MN
01
297601016602
PREF ONE
MN
01
334M3WA
BCBS
MN
01
U59524
UPIN
MN
Enumeration date
08/27/2007
Last updated
08/27/2007
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