Organization
JOHN KLOSTER
Active
Other names
Pequot Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN KLOSTER NELS KLOSTER O,D, (OWNER)
(218) 568-5555
Entity
Organization
Contact information
Practice address
4461 MAIN ST,, PEQUOT LAKES, MN 56472
(218) 568-5555
(218) 568-8904
Mailing address
PO BOX 176, PEQUOT LAKES, MN 56472-0176
(218) 568-5555
(218) 568-8904
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2316
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050325800
—
MN
01
—
2220699
MEDICA
MN
01
—
64756PE
BLUE CROSS/ BLUE SHIELD
MN
Enumeration date
04/07/2008
Last updated
06/18/2008
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