Organization
VISIONARY OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD THEODORE BOGREN O.D. (OPTOMETRIST)
(763) 370-2479
Entity
Organization
Contact information
Practice address
5815 NORELL AVE N, OAK PARK HEIGHTS, MN 55082-1766
(651) 351-3976
(651) 351-3978
Mailing address
3201 ATWOOD CT, STILLWATER, MN 55082-6692
(763) 370-2479
(651) 351-3978
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3169
MN
Other
Enumeration date
07/08/2011
Last updated
07/08/2011
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