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Individual

PETER JAMES HEINEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
8000 LAKELAND AVE N, WALMART VISION CENTER, BROOKLYN PARK, MN 55445
(763) 425-4890
(763) 424-2787
Mailing address
14673 78TH AVE N, MAPLE GROVE, MN 55311
(763) 416-4806

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MN2403
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
22 00055
MEDICA
Enumeration date
09/07/2006
Last updated
07/09/2007
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