Crosslake Eye Center
LBN: Todd M. Wiedel, O.D., Pa
Crosslake Eye Center is an health care organization with primary practice located at 30960 Government Dr , Pequot Lakes MN 56472-1003. The organization recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Suppliers / Eyewear Supplier (Equipment, not the service). Eye and Vision Services Providers / Optometrist is the primary health care specialty.
Todd M. Wiedel, O.D., Pa can be contacted via phone (218) 568-5555, or through Wiedell, Todd M via phone (218) 568-5555.
Contact Information
Primary practice address
30960 Government Dr
Pequot Lakes MN 56472-1003
Phone: (218) 568-5555
Fax: (218) 568-8904
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | ||
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X | 2945 | Minnesota |
Profile Details
| NPI number | 1831428903 |
|---|---|
| LBN Legal business name | Todd M. Wiedel, O.D., Pa |
| DBA Doing business as | Crosslake Eye Center |
| Authorized official | Wiedell, Todd M Doctor of Optometry (OD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 18th, 2009 |
| Last updated | Oct 10th, 2019 - about 6 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831428903 | NPPES |
| Minnesota | MEDICAID | 176684800 | |
| Minnesota | Other | 1BI74PE | |
| Minnesota | Other | 22-05547 |
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