Organization
F & G OPTICAL INC
Active
Other names
Latham Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIRGINIA DOMAIN (CFO)
(952) 476-4185
Entity
Organization
Contact information
Practice address
852 LAKE ST E, UNIT A, WAYZATA, MN 55391-4523
(952) 476-4185
(952) 476-8812
Mailing address
852 LAKE ST E, UNIT A, WAYZATA, MN 55391-4526
(952) 476-4185
(952) 476-8812
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2439
MN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808862400
—
MN
Enumeration date
11/09/2006
Last updated
04/08/2013
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