Organization
LC OPTOMETRIC PC
Active
Other names
LensCrafters
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CRYSTAL ANNE TROM (BUISNESS MANAGER)
(763) 354-9505
Entity
Organization
Contact information
Practice address
12131 ELM CREEK BLVD N, MAPLE GROVE, MN 55369-7093
(763) 416-1983
Mailing address
1260 BROOKDALE DRIVE, BROOKDALE CENTER, BROOKLYN CENTER, MN 55430
(763) 560-9239
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MN2638
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
864687200
—
MN
Enumeration date
05/09/2008
Last updated
05/09/2008
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