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Organization

MAPLE GROVE VISION CLINIC, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LINDA M THIEL (CLINIC ADMINISTRATOR)
(763) 420-8030
Entity
Organization

Contact information

Practice address
13645 GROVE DR, MAPLE GROVE, MN 55311-4405
(763) 420-8030
(763) 420-8342
Mailing address
13645 GROVE DR, MAPLE GROVE, MN 55311-4405
(763) 420-8030
(763) 420-8342

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
762603700
MN
Enumeration date
07/04/2006
Last updated
08/31/2009
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