Organization
MILLE LACS FAMILY EYE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE C HONSTROM (OWNER/OPERATOR)
(320) 495-3500
Entity
Organization
Contact information
Practice address
270 N MAIN ST, WAHKON, MN 56386-4401
(320) 495-3500
(320) 495-3502
Mailing address
PO BOX 39, WAHKON, MN 56386-0039
(320) 495-3500
(320) 495-3502
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760709125
—
MN
Enumeration date
06/15/2010
Last updated
06/23/2010
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