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Individual

DR. MITCHELL DEAN HARSTAD

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
2055 15TH ST N, SAINT CLOUD, MN 56303-1747
(320) 251-1432
(320) 251-7122
Mailing address
2055 15TH ST N, SAINT CLOUD, MN 56303-1747
(320) 251-1432
(320) 251-7122

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1982
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11967HA
BLUE CROSS
MN
01
2211983
MEDICA
MN
Enumeration date
10/06/2005
Last updated
07/08/2007
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