Individual
JESSICA DAWN HISAKO FLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
6500 PENN AVE S, RICHFIELD, MN 55423-1143
(612) 798-1720
Mailing address
8400 BASS LAKE RD APT 111, NEW HOPE, MN 55428-5311
(403) 630-5705
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3716
MN
Other
Enumeration date
08/25/2021
Last updated
09/28/2021
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