Organization
DAKOTA OPTOMETRIC EYE CARE ASSOCIATES, P.A.
Active
Other names
Dakota Optometric Eye Care Associates, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HENNEN O.D. (OWNER)
(651) 455-6631
Entity
Organization
Contact information
Practice address
1540 HUMBOLDT AVE, SUITE 201, SAINT PAUL, MN 55118-3417
(651) 457-2020
Mailing address
1540 HUMBOLDT AVE STE 201, WEST ST PAUL, MN 55118-3481
(651) 457-2020
(651) 457-0368
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1789
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598773780
—
MN
Enumeration date
08/03/2006
Last updated
01/22/2019
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