Individual
DR. TODD C KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 982-7723
(651) 982-7677
Mailing address
11725 STINSON AVE, CHISAGO CITY, MN 55013-9542
(651) 257-8421
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2867
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124140100
—
MN
Enumeration date
10/20/2005
Last updated
11/14/2013
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