Healthcare Provider Details

I. General information

NPI: 1508761784
Provider Name (Legal Business Name): YINGXIN XU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEWEI XU

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MILLER TRUNK HWY
DULUTH MN
55811-5640
US

IV. Provider business mailing address

2120 LONDON RD APT 207
DULUTH MN
55812-2802
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-6838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4102
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: