| Organization Name: | TODD M. WIEDELL, O.D., LLC |
| NPI Number: | 1831428903 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TODD M WIEDELL (OWNER) |
| Mailing Address: | 4461 Main Street Pequot Lakes |
| State: | MN US |
| Postal Code: | 56472 |
| Phone Number: | 2185685555 |
| Fax Number: | 2185688904 |
| NPI Enumeration Date: | 12/18/2009 |
| NPI Last Update Date: | 12/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | 2945 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |