Organization
NORTHEAST EYE CARE OF HUGO
Active
Other names
Northeast Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTI A IVERSON OD (CFO)
(651) 426-3630
Entity
Organization
Contact information
Practice address
14643 MERCANTILE BLVD, SUITE 112, HUGO, MN 55038
(651) 426-3630
Mailing address
14643 MERCANTILE BLVD, SUITE 112, HUGO, MN 55038
(651) 426-3630
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2585
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226680000
—
MN
Enumeration date
03/23/2007
Last updated
05/17/2010
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