Individual
DR. STEVEN PHILLIP GANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
421 DEMERS AVE. NW, EAST GRAND FORKS, MN 56721
(218) 773-3438
(218) 773-1645
Mailing address
2223 8TH ST. SE, EAST GRAND FORKS, MN 56721
(218) 773-3447
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2128
MN
152W00000X
Optometrist
458
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60457
—
ND
Enumeration date
10/05/2006
Last updated
07/08/2007
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