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Individual

BENJAMIN J FOGAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
9801 DUPONT AVE S STE 200, BLOOMINGTON, MN 55431-3200
(952) 888-5800
(952) 567-6156
Mailing address
9801 DUPONT AVE S, SUITE 425, BLOOMINGTON, MN 55431-3100
(952) 567-6092
(952) 567-6176

Taxonomy

Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
3019
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
769412100
MN
01
P00362877
RAILROAD MEDICARE
MN
Enumeration date
09/14/2005
Last updated
09/15/2020
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