Organization
THOMAS N LORENTZSEN & STANTON L ANDRIST PTR
Active
Other names
Moorhead Vision Associates
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN M IVERSON (CLAIMS SUPERVISOR)
(218) 233-1624
Entity
Organization
Contact information
Practice address
420 CENTER AVE, SUITE 41, MOORHEAD, MN 56560
(218) 233-1624
(218) 233-2058
Mailing address
420 CENTER AVE, SUITE 41, MOORHEAD, MN 56560
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281311400
—
MN
01
—
61093
BCBS PIN
MN
01
—
DB3751
RR MEDICARE PIN
ND
01
—
DG1558
RR MEDICARE PIN
MN
Enumeration date
10/05/2006
Last updated
01/03/2008
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