Individual
DR. STACEY JEAN BIENEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OO
Contact information
Practice address
205 W JOHNSON AVE, SUITE 1, WARREN, MN 56762-1118
(218) 745-5151
(218) 745-6000
Mailing address
205 W JOHNSON AVE, SUITE 1, WARREN, MN 56762-1118
(218) 745-5151
(218) 745-6000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2847
MN
152W00000X
Optometrist
609
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
779407000
—
MN
Enumeration date
04/19/2006
Last updated
11/11/2009
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