Provider Demographics
NPI:1124183470
Name:DRAGSTRA, LOREEN KAY
Entity Type:Individual
Prefix:
First Name:LOREEN
Middle Name:KAY
Last Name:DRAGSTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:MN
Mailing Address - Zip Code:56128-3613
Mailing Address - Country:US
Mailing Address - Phone:507-537-1427
Mailing Address - Fax:507-537-1742
Practice Address - Street 1:300 S BRUCE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1934
Practice Address - Country:US
Practice Address - Phone:507-537-1427
Practice Address - Fax:507-537-1742
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant