Individual
JACQUELINE CARYN HONSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
270 N MAIN ST, WAHKON, MN 56386-4401
(320) 495-3500
(320) 495-3502
Mailing address
270 N MAIN ST, PO BOX 39, WAHKON, MN 56386-4401
(320) 495-3500
(320) 495-3502
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2148
MN
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164525044
—
MN
Enumeration date
04/26/2010
Last updated
04/26/2010
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