Organization
THEOBALD FAMILY EYE CARE, LLP
Active
Other names
Theobald Family Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA THEOBALD O.D. (OWNER/PARTNER)
(218) 624-2095
Entity
Organization
Contact information
Practice address
416 N CENTRAL AVE, DULUTH, MN 55807-2548
(218) 624-2095
(218) 624-9545
Mailing address
3308 W ARROWHEAD RD, DULUTH, MN 55811-4000
(218) 727-6400
(218) 464-4277
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402964000
—
MN
01
—
6C246TH
BCBS & FIRST PLAN
MN
01
—
CB6890
RAILROAD MEDICARE
MN
Enumeration date
10/04/2006
Last updated
11/24/2015
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