Healthcare Provider Details

I. General information

NPI: 1285565374
Provider Name (Legal Business Name): JENNA NICOLE GOEPPNER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5266 W 74TH ST
EDINA MN
55439-2223
US

IV. Provider business mailing address

5266 W 74TH ST
EDINA MN
55439-2223
US

V. Phone/Fax

Practice location:
  • Phone: 952-486-7858
  • Fax: 952-674-4641
Mailing address:
  • Phone: 952-486-7858
  • Fax: 952-674-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4055
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: