MEDICARE: DEAN W STENSRUD OD

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	1361	MN

General Provider Information

NPI Number	:	1720066582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN W STENSRUD OD

Provider Business Mailing Address
First Line	:	8401 GOLDEN VALLEY RD
Second Line	:	SUITE 330
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55427-4486
Country	:	US
Telephone Number	:	763-383-4130
Fax Number	:	763-383-4147

Provider Business Practice Location Address
First Line	:	3366 OAKDALE AVE N
Second Line	:	SUITE 402
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2948
Country	:	US
Telephone Number	:	763-416-7600
Fax Number	:

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/08/2007

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