Organization
HUXLEY OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN POLEHONKA (OWNER)
(651) 403-0553
Entity
Organization
Contact information
Practice address
1595 HIGHWAY 36 W STE 120, ROSEVILLE, MN 55113-1092
(651) 621-3684
(651) 389-0333
Mailing address
1595 HIGHWAY 36 W STE 120, ROSEVILLE, MN 55113-1092
(651) 403-0553
(651) 389-0333
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250156
—
MN
Enumeration date
12/09/2021
Last updated
12/09/2021
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