Organization
CENTRAL MINNESOTA RETINA CONSULTANTS, PLLC
Active
Other names
Central Minnesota Retina Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE S REYNOLDS MD, PH. D. (OWNER)
(320) 230-8555
Entity
Organization
Contact information
Practice address
2330 TROOP DR, SUITE 104, SARTELL, MN 56377-4530
(320) 230-8555
(320) 230-8556
Mailing address
2330 TROOP DR, SUITE 104, SARTELL, MN 56377-4530
(320) 230-8555
(320) 230-8556
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
45473
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
569S2CE
BLUECROSS BLUESHIELD
—
05
—
807932300
—
MN
Enumeration date
12/03/2009
Last updated
12/03/2009
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