Organization
JL WALSH PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE J SIMMONS (OFFICE MANAGER)
(651) 565-3687
Entity
Organization
Contact information
Practice address
183 MAIN ST W, WABASHA, MN 55981-1236
(651) 565-3687
Mailing address
183 MAIN ST W, WABASHA, MN 55981-1236
(651) 565-3687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2607
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D02542
MEDICARE RAILROAD
MN
Enumeration date
09/07/2007
Last updated
11/10/2012
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