Individual
DR. CRAIG ROBERTS MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1720 HIGHWAY 59 S, THIEF RIVER FALLS, MN 56701-4331
(218) 681-4747
Mailing address
1720 HIGHWAY 59 S, THIEF RIVER FALLS, MN 56701-4331
(218) 681-4747
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1891
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1026440
PREFERRED ONE
—
01
—
140661
UCARE
MN
01
—
2201140
MEDICA
—
01
—
3902360001
DURABLE MEDICAL EQUIPMENT
MN
01
—
410044422
RR MEDICARE
—
05
—
457323400
—
MN
01
—
61B37MI
BLUE CROSS BLUE SHIELD
MN
01
—
71973
HEALTH PARTNERS
—
Enumeration date
09/16/2006
Last updated
10/24/2011
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