Organization
ACADEMY CONTACT LENS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MARK CAVANAGH O.D. (PRESIDENT)
(651) 636-2020
Entity
Organization
Contact information
Practice address
2655 INNSBRUCK DR, SUITE B, NEW BRIGHTON, MN 55112-9303
(651) 636-2020
(651) 633-5036
Mailing address
2655 INNSBRUCK DR, SUITE B, NEW BRIGHTON, MN 55112-9303
(651) 636-2020
(651) 633-5036
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2236
MN
Other
Enumeration date
03/13/2007
Last updated
03/18/2009
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