Organization · NPI-2

Chad Dockter Od Ltd

Clinic/Center · Eden Prairie, MN

NPI number1508093063
StatusActive
Last updated in NPPESJun 11, 2009

Details

NPI
1508093063
Entity type
Organization (NPI-2)
Legal business name
Chad Dockter Od Ltd
Organization subpart
No
Enumeration date
Jun 11, 2009
Last updated
Jun 11, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

8225 Flying Cloud Dr
Eden Prairie, MN 55344-5315

Phone 952-563-0246

Mailing address

817 Ramsey Ave
Carver, MN 55315-4515

Phone 952-448-6560

Authorized official

Chad Ray Dockter
Optometrist
9524486560

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