Organization
CLOQUET EYECARE AND CONTACT LENS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES A REEDSTROM O.D. (OPTOMETRIST)
(218) 879-2400
Entity
Organization
Contact information
Practice address
807 CLOQUET AVE, CLOQUET, MN 55720-1675
(218) 879-2400
Mailing address
807 CLOQUET AVE, CLOQUET, MN 55720-1675
(218) 879-2400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1611
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042338600
—
MN
01
—
T63074
UPIN
MN
Enumeration date
08/29/2008
Last updated
02/03/2009
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