Individual
DR. LANETTE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
206 DIVISION ST, WAITE PARK, MN 56387-1331
(320) 253-0365
Mailing address
1205 20TH AVE S, SARTELL, MN 56377-2488
(337) 367-3834
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1393-531T
LA
152W00000X
Optometrist
Primary
3801
MN
152W00000X
Optometrist
6042T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA6042
EYEMED PROVIDER NUMBER
LA
Enumeration date
02/17/2007
Last updated
10/03/2022
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