Provider Demographics
NPI:1174591945
Name:VOLD, MICHAEL N (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:VOLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:715 N SIBLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-1765
Mailing Address - Country:US
Mailing Address - Phone:320-693-3100
Mailing Address - Fax:320-693-2312
Practice Address - Street 1:715 N SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-1765
Practice Address - Country:US
Practice Address - Phone:320-693-3100
Practice Address - Fax:320-693-2312
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist