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Organization

VANDESTEEG & LARSON OPTOMETRIC CLINIC PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. STEPHEN MARK LARSON OD (PRESIDENT)
(320) 352-2774
Entity
Organization

Contact information

Practice address
314 MAIN ST S, SAUK CENTRE, MN 56378-1349
(320) 352-2774
Mailing address
314 MAIN ST S, SAUK CENTRE, MN 56378-1349
(320) 352-2774

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1709
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
156323802
MN
Enumeration date
09/13/2006
Last updated
09/18/2014
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