Individual
WADE NOOLEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ABOC NCLC
Contact information
Practice address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 389-2470
Mailing address
12810 NICOLLET AVE, BURNSVILLE, MN 55337-2814
(952) 895-8479
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
085567
MN
Other
Enumeration date
03/23/2018
Last updated
03/23/2018
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