Organization
RIVER LAKE CLINIC LLC
Active
Other names
River Lake Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHEL E. HANEN-SMITH O. D., M. S. (MEMBER)
(612) 722-1003
Entity
Organization
Contact information
Practice address
4323 E LAKE ST, MINNEAPOLIS, MN 55406-2307
(612) 722-1003
(612) 721-6336
Mailing address
4323 E LAKE ST, MINNEAPOLIS, MN 55406-2307
(612) 722-1003
(612) 721-6336
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP2754
MN
103TA0700X
Adult Development & Aging Psychologist
LP2754
MN
103TB0200X
Cognitive & Behavioral Psychologist
LP2754
MN
103TC1900X
Counseling Psychologist
LP2754
MN
103TF0000X
Family Psychologist
LP2754
MN
103TF0200X
Forensic Psychologist
LP2754
MN
152W00000X
Optometrist
Primary
1652
MN
152W00000X
Optometrist
3331
MN
152WC0802X
Corneal and Contact Management Optometrist
3331
MN
152WL0500X
Low Vision Rehabilitation Optometrist
3331
MN
152WP0200X
Pediatric Optometrist
3331
MN
152WS0006X
Sports Vision Optometrist
3331
MN
152WV0400X
Vision Therapy Optometrist
1652
MN
152WX0102X
Occupational Vision Optometrist
1652
MN
Other
Enumeration date
02/26/2007
Last updated
01/30/2014
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