Dieter, Michael V

Dieter, Michael V is an sole proprietor health care provider with primary practice located at 12000 Elm Creek Blvd N Ste L90 , Maple Grove MN 55369-7168. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Dieter, Michael V can be contacted via phone (763) 416-0919.

Contact Information

Primary practice address
12000 Elm Creek Blvd N Ste L90 Maple Grove MN 55369-7168
Phone: (763) 416-0919
Fax: (763) 416-0992
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1693 Minnesota

Profile Details

NPI number 1245374115
LBN Legal business name Dieter, Michael V
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 16th, 2007
Last updated Jun 8th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245374115 NPPES
Minnesota Other 1396DI BLUE CROSS BLUE SHIELD
Minnesota MEDICAID 844323800 BLUE CROSS BLUE SHIELD

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