Individual
SAM DONOVAN VILLELLA I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
701 DELLWOOD ST S, CAMBRIDGE, MN 55008-1920
(763) 689-7700
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2836
MN
Other
Enumeration date
04/04/2006
Last updated
03/11/2021
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