Provider Demographics
NPI:1558312249
Name:NYQUIST, AMY J (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:NYQUIST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-0699
Mailing Address - Country:US
Mailing Address - Phone:320-587-6308
Mailing Address - Fax:866-203-6862
Practice Address - Street 1:1455 MONTREAL ST SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3318
Practice Address - Country:US
Practice Address - Phone:320-587-6308
Practice Address - Fax:866-203-6862
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV00655Medicare UPIN