Healthcare Provider Details

I. General information

NPI: 1972445179
Provider Name (Legal Business Name): JOHANNA KINSER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15704 90TH ST NE # 100
OTSEGO MN
55330-7448
US

IV. Provider business mailing address

9241 34TH AVE N
NEW HOPE MN
55427-1764
US

V. Phone/Fax

Practice location:
  • Phone: 763-241-1090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4056
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: