Organization
PENNY P VIZINA OD LLC
Active
Other names
Family Vision Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PENNY PETERSON VIZINA O.D. (OWNER)
(507) 451-5800
Entity
Organization
Contact information
Practice address
121 W MAIN ST, OWATONNA, MN 55060-2970
(507) 451-5800
Mailing address
121 W MAIN ST, OWATONNA, MN 55060-2970
(507) 451-5800
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2381
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0776480
—
MN
01
—
410003463
MEDICARE PROVIDER NUMBER
MN
Enumeration date
08/26/2010
Last updated
09/25/2014
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