Individual
MICHAEL V DIETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
12000 ELM CREEK BLVD N STE L90, MAPLE GROVE, MN 55369-7168
(763) 416-0919
(763) 416-0992
Mailing address
12000 ELM CREEK BLVD N STE L90, MAPLE GROVE, MN 55369-7168
(763) 416-0919
(763) 416-0992
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1693
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396DI
BLUE CROSS BLUE SHIELD
MN
05
—
844323800
—
MN
Enumeration date
02/16/2007
Last updated
06/08/2015
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