Healthcare Provider Details

I. General information

NPI: 1700847035
Provider Name (Legal Business Name): TRENT D COLE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 10TH ST N
OAKDALE MN
55128-5938
US

IV. Provider business mailing address

PO BOX 171
SAINT MICHAEL MN
55376-0171
US

V. Phone/Fax

Practice location:
  • Phone: 651-738-8040
  • Fax: 651-714-0759
Mailing address:
  • Phone: 763-242-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2729
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: