Individual
DR. MARK ROBERT HALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2311 WAYZATA BLVD S, MINNEAPOLIS, MN 55405-2119
(612) 377-5192
Mailing address
2311 WAYZATA BLVD S, MINNEAPOLIS, MN 55405-2119
(612) 377-5192
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3233
MN
Other
Enumeration date
07/01/2011
Last updated
12/09/2011
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