| Todd M. Wiedel, O.d., Pa | |
|
30960 Government Dr, Pequot Lakes, MN 56472-1003 | |
| (218) 568-5555 | |
| (218) 568-8904 |
| Full Name | Todd M. Wiedel, O.d., Pa |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 30960 Government Dr, Pequot Lakes, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831428903 | NPI | - | NPPES |
| 176684800 | Medicaid | MN | |
| 1BI74PE | Other | MN | BCBS |
| 22-05547 | Other | MN | MEDICA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Primary |
| 332H00000X | Eyewear Supplier | 2945 (Minnesota) | Secondary |
| Provider Name | Todd M Wiedell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1295781425 PECOS PAC ID: 9931179157 Enrollment ID: I20040727000546 |
| Mailing Address | Practice Location Address |
|---|---|
| Todd M. Wiedel, O.d., Pa Po Box 176, Pequot Lakes, MN 56472-0176 Ph: (218) 568-5555 | Todd M. Wiedel, O.d., Pa 30960 Government Dr, Pequot Lakes, MN 56472-1003 Ph: (218) 568-5555 |
Dr. Todd M Wiedell, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 30960 Government Dr, Pequot Lakes, MN 56472 Phone: 218-568-5555 Fax: 218-568-8904 | |
John Kloster Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4461 Main St,, Pequot Lakes, MN 56472 Phone: 218-568-5555 Fax: 218-568-8904 |