Individual
DR. SARA RAE BETTERLY WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2330 SIOUX TRL NW, PRIOR LAKE, MN 55372-9077
(952) 233-2955
Mailing address
712 HAGUE AVE APT 2, SAINT PAUL, MN 55104-6951
(651) 210-6202
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3116
MN
Other
Enumeration date
07/25/2008
Last updated
07/25/2008
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