Individual
MARY LYNN GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD FCOVD
Contact information
Practice address
560 CEDAR STREET, MONTICELLO, MN 55362-8403
(763) 271-2020
Mailing address
560 CEDAR STREET, MONTICELLO, MN 55362-8403
(763) 271-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2734
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030242200
—
MN
01
—
127621
U CARE
MN
01
—
219J5GR
BCBS
MN
01
—
2201727
MEDICA
MN
01
—
HP29102
HEALTH PARTNERS
MN
01
—
P00236593
MEDICARE RAILROAD
MN
Enumeration date
11/16/2006
Last updated
12/27/2014
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