Individual
THOMAS J KOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
418 WEST 3RD ST, RED WING, MN 55065
(651) 388-0738
(651) 388-0739
Mailing address
3780 GRANADA PLAZA NO, OAKDALE, MN 55128
(651) 779-2130
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1599
OR
152W00000X
Optometrist
1879
WI
152W00000X
Optometrist
Primary
1928
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202055
MEDICA
MN
01
—
283R6K0
BCBS
MN
Enumeration date
09/13/2006
Last updated
07/08/2007
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