Organization
MINNESOTA VISION OUTREACH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL WOLFSON O.D. (OWNER)
(763) 585-8414
Entity
Organization
Contact information
Practice address
9905 45TH AVENUE NORTH, SUITE 110, PLYMOUTH, MN 55422-3315
(763) 595-8414
(763) 595-8414
Mailing address
9905 45TH AVENUE NORTH, SUITE 110, PLYMOUTH, MN 55422-3315
(763) 595-8414
(763) 595-8438
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1706
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096744100
—
MN
01
—
102877
UCARE
MN
01
—
19467WO
BCBS OF MN
MN
01
—
2100002
MEDICA PRIMARY
MN
01
—
2115998
MEDICA CHOICE
MN
01
—
23979
HEALTH PARTNERS
MN
01
—
2499537
MHP
MN
01
—
3C780MI
BLUE PLUS
MN
Enumeration date
05/05/2007
Last updated
11/10/2016
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