Mickelson, Craig Roberts

Mickelson, Craig Roberts is an individual health care provider with primary practice located at 1720 Highway 59 S , Thief River Falls MN 56701-4331. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Mickelson, Craig Roberts can be contacted via phone (218) 681-4747.

Contact Information

Primary practice address
1720 Highway 59 S Thief River Falls MN 56701-4331
Phone: (218) 681-4747
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1891 Minnesota

Profile Details

NPI number 1184720013
LBN Legal business name Mickelson, Craig Roberts
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 16th, 2006
Last updated Oct 24th, 2011 - about 13 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 1184720013 NPPES
Other 410044422 RR MEDICARE
Other 140661 RR MEDICARE
MEDICAID 457323400 RR MEDICARE
Other 71973 RR MEDICARE
Other 1026440 RR MEDICARE
Other 61B37MI RR MEDICARE
Other 2201140 RR MEDICARE
Other 3902360001 RR MEDICARE

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