Individual
RICHARD NEAL KITTELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ABOC
Contact information
Practice address
918 WASHINGTON AVE, DETROIT LAKES, MN 56501-3402
(218) 847-8021
(218) 846-9552
Mailing address
918 WASHINGTON AVE, DETROIT LAKES, MN 56501-3402
(218) 847-8021
(218) 846-9552
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
03590
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1C991OP
BLUE CROSS BLUE SHIELD OF MINNESOTA
MN
01
—
2100679
MEDICA
MN
05
—
498762400
—
MN
Enumeration date
05/21/2008
Last updated
03/07/2012
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