Krietlow, Chad M.

Krietlow, Chad M. is an sole proprietor health care provider with primary practice located at 260 Northtown Dr Ne , Blaine MN 55434-1037. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Krietlow, Chad M. can be contacted via phone (763) 784-9049.

Contact Information

Primary practice address
260 Northtown Dr Ne Blaine MN 55434-1037
Fax: (763) 717-6939
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X MN2821 Minnesota

Profile Details

NPI number 1295849917
LBN Legal business name Krietlow, Chad M.
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 19th, 2006
Last updated Jun 21st, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295849917 NPPES
Minnesota MEDICAID 916244500

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