Doctor Name: | MR. JOHN PETER VORDERBRUGGEN |
NPI Number: | 1013187855 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | 2729202 |
Business Practice Address: | 901 N 23rd Ave W Duluth, MN - 558061244 |
Business Phone Number: | 2187260078 |
Business Fax Number: | |
Mailing Address: | 901 N 23rd Ave W, DULUTH |
State: | MN |
Postal Code: | 558061244 |
Phone Number: | 2187260078 |
Fax Number: | |
NPI Enumeration Date: | 03/07/2008 |
NPI Last Update Date: | 03/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 2729202 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |