Organization
ROSEAU/WARROAD EYE CLINIC, P.A.
Active
Other names
Erickson Dieter Optometrists
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROSS JAMES OLSON O.D. (OWNER/OPTOMETRIST)
(218) 386-2081
Entity
Organization
Contact information
Practice address
301 LAKE STREET NE, WARROAD, MN 56763
(218) 386-2081
(218) 386-1217
Mailing address
BOX 446, 301 LAKE STREET NE, WARROAD, MN 56763
(218) 386-2081
(218) 386-1217
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
#1693
MN
152W00000X
Optometrist
1618
MN
152W00000X
Optometrist
1693
MN
152W00000X
Optometrist
2946
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14000DI
BLUE CROSS BLUE SHIELD
MN
01
—
14023ER
BLUE CROSS BLUE SHIELD
MN
05
—
275823700
—
MN
Enumeration date
11/09/2006
Last updated
08/05/2014
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