Organization
SOUTHDALE OPTICAL CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADLEY JON PETERSON (PRESIDENT)
(952) 925-9550
Entity
Organization
Contact information
Practice address
6533 DREW AVE S, EDINA, MN 55435-2103
(952) 925-9550
(952) 925-9748
Mailing address
6533 DREW AVE S, EDINA, MN 55435-2103
(952) 925-9550
(952) 925-9748
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
11/29/2005
Last updated
06/16/2009
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