Organization
BLUE EARTH VALLEY EYE CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT DANIEL JOHNSON (PRESIDENT)
(507) 893-4532
Entity
Organization
Contact information
Practice address
21 MAIN STREET SOUTH, WINNEBAGO, MN 56098
(507) 893-4532
(507) 893-4854
Mailing address
PO BOX 717, WINNEBAGO, MN 56098
(507) 893-4532
(507) 893-4854
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/01/2006
Last updated
08/22/2020
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