Provider Demographics
NPI:1770694986
Name:SUNDHAGEN, LEANN F (OD)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:F
Last Name:SUNDHAGEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 HWY 15 SOUTH
Mailing Address - Street 2:MIDWEST VISION
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350
Mailing Address - Country:US
Mailing Address - Phone:320-587-2370
Mailing Address - Fax:320-587-2373
Practice Address - Street 1:1060 HWY 15 SOUTH
Practice Address - Street 2:MIDWEST VISION
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350
Practice Address - Country:US
Practice Address - Phone:320-587-2370
Practice Address - Fax:320-587-2373
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63087Medicare UPIN