Individual
DR. PAUL W WYSOSKI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3015 HIGHWAY 29 S, STE 4155, ALEXANDRIA, MN 56308-3486
(320) 759-1130
(320) 759-1129
Mailing address
3015 HIGHWAY 29 S, STE 4155, ALEXANDRIA, MN 56308-3486
(320) 759-1130
(320) 759-1129
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2383
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30701135
PW
—
01
—
66Q23RU
BCBS
—
01
—
66Q26RU
BCBS
—
Enumeration date
08/24/2005
Last updated
07/09/2007
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