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) 463-2020
Entity
Organization
Contact information
Practice address
306 N MAIN, ROSEAU, MN 56751
(218) 463-2020
(218) 463-2055
Mailing address
306 N MAIN, ROSEAU, MN 56751
(218) 463-2020
(218) 463-2055
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1618
MN
152W00000X
Optometrist
Primary
1693
MN
152W00000X
Optometrist
2946
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13951
BLUE CROSS BLUE SHIELD
MN
01
—
13962
BLUE CROSS BLUE SHIELD
MN
01
—
192K5YE
BLUE CROSS BLUE SHIELD
MN
05
—
275823700
—
MN
05
—
295457500
—
MN
05
—
844323800
—
MN
01
—
HP40537
HEALTHPARTNERS
MN
01
—
HP42709
HEALTHPARTNERS
MN
Enumeration date
10/27/2006
Last updated
08/05/2014
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