Individual
JILL SUZANNE MELICHER LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9801 DUPONT AVE S, 200, BLOOMINGTON, MN 55431-3100
(952) 888-5800
Mailing address
9801 DUPONT AVE S, SUITE 425, BLOOMINGTON, MN 55431-3100
(952) 888-5800
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
105147
MN
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
53626
MN
Other
Enumeration date
01/22/2007
Last updated
10/17/2017
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