Organization
MICKELSON EYE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG R MICKELSON (OWNER/ OPTOMETRIST)
(218) 683-3937
Entity
Organization
Contact information
Practice address
126 LABREE AVE S, THIEF RIVER FALLS, MN 56701-2819
(218) 683-3937
(218) 683-4557
Mailing address
126 LABREE AVE S, PO BOX 521, THIEF RIVER FALLS, MN 56701-2819
(218) 683-3937
(218) 683-4557
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1891
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1026440
PREFERRED ONE
MN
01
—
140661
UCARE
MN
01
—
2201140
MEDICA
MN
01
—
61B37MI
BLUE CROSS BLUE SHIELD
MN
01
—
71973
HEALTH PARTNERS
MN
Enumeration date
07/13/2006
Last updated
04/17/2008
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