Organization
VANDESTEEG & LARSON OPTOMETRIC CLINIC, PA
Active
Other names
Glacial Ridge Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN D LARSON OD (OWNER)
(320) 634-4516
Entity
Organization
Contact information
Practice address
24 1ST ST SE, GLENWOOD, MN 56334-1619
(320) 634-4516
(320) 634-4520
Mailing address
24 1ST STREET SE, GLENWOOD, MN 56334
(320) 634-4516
(320) 634-4520
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10000202944
—
MN
05
—
496063700
—
MN
Enumeration date
11/18/2014
Last updated
07/16/2025
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