Healthcare Provider Details

I. General information

NPI: 1467712133
Provider Name (Legal Business Name): EMILY ANN UFKEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 COUNTRY RD 42 EAST
BURNSVILLE MN
55337
US

IV. Provider business mailing address

16250 DULUTH AVE SE
PRIOR LAKE MN
55372-2882
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-1400
  • Fax:
Mailing address:
  • Phone: 952-447-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3406
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6165
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: