Individual
SARA A FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1611 ANNE ST NW, BEMIDJI, MN 56601-5114
(218) 333-2020
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3005
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202923
MEDICA
MN
01
—
375M4FR
BLUE CROSS MN
MN
05
—
539124500
—
MN
Enumeration date
07/10/2006
Last updated
03/07/2022
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