Healthcare Provider Details

I. General information

NPI: 1255711859
Provider Name (Legal Business Name): MEGHAN EARLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 04/20/2018
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

7011 10TH ST N
OAKDALE MN
55128-5938
US

V. Phone/Fax

Practice location:
  • Phone: 651-738-8040
  • Fax:
Mailing address:
  • Phone: 651-738-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number3433
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: