Individual
WENDY SEYLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
13481 60TH ST N SUITE 200, ST CROIX VISION CENTER, STILLWATER, MN 55082
(651) 439-6400
(651) 439-6405
Mailing address
1037 GRIFFIN AVE, MAHTOMEDI, MN 55115-1509
(651) 493-2677
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2105
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11960
EYE MED / COLE VISION
MN
01
—
3C312SE
BLUE CROSS BLUE SHIELD
MN
05
—
670360700
—
MN
Enumeration date
10/04/2006
Last updated
01/30/2014
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