Individual
MARTIN J THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3308 W ARROWHEAD RD, DULUTH, MN 55811-4000
(218) 727-6400
Mailing address
3308 W ARROWHEAD RD, DULUTH, MN 55811-4000
(218) 727-6400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2549
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110960
UCARE
MN
01
—
2203074
MEDICA
MN
01
—
2207594
MEDICA
MN
01
—
6C248TH
FIRST PLAN MINNESOTA
MN
01
—
897821023475
PREFERRED ONE
MN
01
—
A62871023475
PREFERRED ONE
MN
Enumeration date
02/23/2006
Last updated
07/08/2007
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