Basic Information
| Provider Information | |||||||||
| NPI: | 1124183470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAGSTRA | ||||||||
| FirstName: | LOREEN | ||||||||
| MiddleName: | KAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 193 130TH AVE | ||||||||
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| City: | EDGERTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561283613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075371427 | ||||||||
| FaxNumber: | 5075371742 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S BRUCE ST | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562581934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075371427 | ||||||||
| FaxNumber: | 5075371742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1101X | MN | Y | Eye and Vision Services Providers | Technician/Technologist | Ophthalmic Assistant |
No ID Information.