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Organization

INDEX 53 OPT ICAL CO.INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAWRENCE A RUDOLPH (PRES OPTICIAN)
(320) 252-9380
Entity
Organization

Contact information

Practice address
306 MAIN ST E, ST STEPHEN, MN 56375
(320) 252-9380
(320) 654-9502
Mailing address
PO BOX 1111, ST CLOUD, MN 56302
(320) 252-9380
(320) 654-9502

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
332BC3200X
Customized Equipment (DME)

Other

Enumeration date
04/29/2008
Last updated
03/27/2014
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