Individual
MICHAEL D ACKERMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
117 W CENTER ST, LAKE CITY, MN 55041
(651) 345-3039
(651) 345-3506
Mailing address
117 W CENTER ST, LAKE CITY, MN 55041
(651) 345-3039
(651) 345-3506
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2672
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
455515500
—
MN
01
—
80G78AC
BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/02/2006
Last updated
02/26/2008
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