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Individual

ROBERT DODGE

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
12737 RIVERDALE BLVD NW, COON RAPIDS, MN 55448-1253
(763) 433-3468
Mailing address
PO BOX 48451, COON RAPIDS, MN 55448-0451

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2510
MN

Other

Enumeration date
06/01/2005
Last updated
07/09/2007
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