MEDICARE: ANTHONY DOFFIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3004	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366520538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY DOFFIN O.D.

Provider Business Mailing Address
First Line	:	3026 ASPEN LAKE DR NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-7517
Country	:	US
Telephone Number	:	651-747-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	2929 PENTAGON DRIVE
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55418
Country	:	US
Telephone Number	:	612-781-4730
Fax Number	:	763-784-9627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	11/29/2023

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