Organization
MINNESOTA OPTICAL LLC
Active
Other names
dba Pearle Vision
Organization subpart
No
Provider details
NPI number
Authorized official
GARY TONSAGER (CHIEF OFFICER)
(763) 241-2083
Entity
Organization
Contact information
Practice address
19576 HOLT ST NW, ELK RIVER, MN 55330
(763) 241-2083
(763) 241-3801
Mailing address
19576 HOLT ST NW, ELK RIVER, MN 55330
(763) 241-2083
(763) 241-3801
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
MN
152W00000X
Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6627600001
DME
MN
Enumeration date
05/10/2007
Last updated
03/09/2012
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