Individual
ALLISON LYNN WIEDEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
570 NORTHTOWN DR NE, BLAINE, MN 55434-1043
(763) 784-4081
(866) 822-2088
Mailing address
570 NORTHTOWN DR NE, BLAINE, MN 55434-1043
(763) 784-4081
(866) 822-2088
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3164
MN
152W00000X
Optometrist
OPT002322
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3164
MN OPTOMETRY LICENSE
MN
01
—
OPT002322
STATE LICENSE
GA
Enumeration date
09/28/2006
Last updated
08/02/2013
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