Birch Lake Vision Group, Llc.
NPI #1609921899 in White Bear Lake, Minnesota
Provider Information
- NPI Number
- 1609921899
- Entity Type
- Organization
- Organization Name
- Birch Lake Vision Group, Llc.
- Primary Specialty
- Optometrist
- Enumeration Date
- Jan 25, 2007
- Last Updated
- Dec 2, 2009
Practice Location
- Address
- 4720 WHITE BEAR PKWY
- City
- White Bear Lake
- State
- Minnesota
- ZIP Code
- 55110-3336
- Phone
- (651) 426-2747
Authorized Official
- Name
- DR. BRIAN DWIGHT GRUDEM, O.D.
- Title
- CFO
- Phone
- (651) 426-2747
Specialties & Taxonomy Codes
| Specialty |
|---|
| Optometrist |
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