Individual
TANYA S ERNTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4455 HIGHWAY 169 N, PLYMOUTH, MN 55442-2897
(763) 559-7358
(763) 559-2167
Mailing address
4455 HIGHWAY 169 N, PLYMOUTH, MN 55442-2897
(763) 559-7358
(763) 559-2167
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2927
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
717678300
—
MN
Enumeration date
01/05/2006
Last updated
11/17/2020
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