Organization
ANDOVER OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAINE SANGREN (VICE PRES)
(763) 421-0141
Entity
Organization
Contact information
Practice address
13855 ROUND LAKE BLVD NW, ANDOVER, MN 55304-3664
(763) 421-0141
(763) 421-0334
Mailing address
13855 ROUND LAKE BLVD NW, ANDOVER, MN 55304-3664
(763) 421-0141
(763) 421-0334
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
—
—
156FC0801X
Contact Lens Fitter
Primary
—
—
156FX1800X
Optician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10294AN
BCBS
MN
01
—
114915
UCARE
MN
01
—
16125
HEALTH PARTNERS
MN
01
—
2115818
MEDICA
MN
01
—
747001
PREFERREDONE
MN
Enumeration date
12/08/2006
Last updated
02/06/2008
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