Individual
THERESIA F DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
344 E BROADWAY, MALL OF AMERICA, BLOOMINGTON, MN 55425-5514
(952) 858-8414
(952) 858-8416
Mailing address
344 E BROADWAY, MALL OF AMERICA, BLOOMINGTON, MN 55425-5514
(952) 858-8414
(952) 858-8416
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2530
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301019800
—
MN
Enumeration date
07/04/2006
Last updated
01/22/2013
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