Provider Demographics
NPI:1679727697
Name:STEPHEN J. REIGSTAD OPTOMETRY INC.
Entity Type:Organization
Organization Name:STEPHEN J. REIGSTAD OPTOMETRY INC.
Other - Org Name:STEPHEN'S DOWNTOWN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:REIGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-262-4546
Mailing Address - Street 1:901 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2136
Mailing Address - Country:US
Mailing Address - Phone:320-262-4546
Mailing Address - Fax:320-214-7220
Practice Address - Street 1:330 4TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3332
Practice Address - Country:US
Practice Address - Phone:320-214-7207
Practice Address - Fax:320-214-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty