Organization
VANDESTEEG & LARSON OPTOMETRIC CLINIC PA
Active
Other names
Glacial Ridge Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN M LARSON OD (OWNER)
(320) 634-4516
Entity
Organization
Contact information
Practice address
24 1ST ST SE, GLENWOOD, MN 56334-1619
(320) 634-4516
(320) 634-4520
Mailing address
24 1ST ST SE, GLENWOOD, MN 56334-1619
(320) 634-4516
(320) 634-4520
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1709
MN
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
10/08/2014
Last updated
07/16/2025
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