Individual
TREVOR J FOSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2180 TROOP DR, SARTELL, MN 56377-4563
(320) 258-3915
(320) 258-3917
Mailing address
2180 TROOP DR, SARTELL, MN 56377-4563
(320) 258-3915
(320) 258-3917
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MN3499
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336597079
—
MN
Enumeration date
06/02/2016
Last updated
06/28/2022
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