Provider Demographics
NPI:1306206446
Name:GLACIAL RIDGE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GLACIAL RIDGE HOSPITAL DISTRICT
Other - Org Name:GLENWOOD FAMILY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:STENSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-634-2208
Mailing Address - Street 1:16 WEST MINNESOTA AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334
Mailing Address - Country:US
Mailing Address - Phone:320-334-3264
Mailing Address - Fax:320-334-3256
Practice Address - Street 1:16 WEST MINNESOTA AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334
Practice Address - Country:US
Practice Address - Phone:320-334-3264
Practice Address - Fax:320-334-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2417152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty