Healthcare Provider Details

I. General information

NPI: 1104491687
Provider Name (Legal Business Name): MADELINE ELMLAND OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 W 50TH ST
MINNEAPOLIS MN
55410-2101
US

IV. Provider business mailing address

3102 W 50TH ST
MINNEAPOLIS MN
55410-2101
US

V. Phone/Fax

Practice location:
  • Phone: 833-969-1228
  • Fax:
Mailing address:
  • Phone:
  • Fax: 910-451-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3725
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: