Avera McKennan
Organization Active NPI Optometrist · Windom, MN
NPI 1538613633 · NPPES record last updated Oct 24, 2018
Key facts
- NPI
- 1538613633
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- AVERA MCKENNAN
- Practice address
- 1006 4TH Ave
Windom, MN 56101-1440 - Phone
- (507) 831-2429
- NPI assigned
- Aug 8, 2016
- Organization subpart
- No
Authorized official
- Name
- David Flicek
- Title
- Ceo/President
- Phone
- (605) 322-8000
Member of 1
National Provider Directory
Locations
1006 4th Ave
Windom, MN 56101
Phone (507) 831-2429
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
1006 4TH Ave
Windom, MN 56101-1440
Mailing address
1006 4TH Ave
Windom, MN 56101-1440
Phone (507) 831-2429
Other names
- Avera Medical Group Optometry Windom
Other providers in Windom, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.