Individual
STANTON L ANDRIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
420 CENTER AVE, SUITE 41, MOORHEAD, MN 56560-1957
(218) 233-1624
(218) 233-2058
Mailing address
420 CENTER AVE, SUITE 41, MOORHEAD, MN 56560-1957
(218) 233-1624
(218) 233-2058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2021
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60344
—
ND
01
—
61000AN
BCBS PIN
MN
05
—
947723300
—
MN
01
—
P01065711
RR MEDICARE
MN
Enumeration date
09/02/2005
Last updated
09/27/2012
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