Organization
G.R. THOMAS JR OD PA
Active
Other names
Maple Grove Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALISSA LINDSTROM CPO (INSURANCE COORDINATOR)
(763) 420-6981
Entity
Organization
Contact information
Practice address
7880 MAINSTREET, MAPLE GROVE, MN 55369-7081
(763) 420-6981
(763) 773-7253
Mailing address
7880 MAIN ST N, MAPLE GROVE, MN 55369-7081
(763) 420-6981
(763) 773-7253
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1457
MN
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
652323400
—
MN
Enumeration date
01/02/2008
Last updated
03/04/2011
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