Healthcare Provider Details

I. General information

NPI: 1881788016
Provider Name (Legal Business Name): STACY MARIE HINKEMEYER-COLATRELLA O.D. FAAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/30/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 TROOP DR
SARTELL MN
56377-7504
US

IV. Provider business mailing address

2180 TROOP DR
SARTELL MN
56377-7504
US

V. Phone/Fax

Practice location:
  • Phone: 320-258-3915
  • Fax: 320-258-3917
Mailing address:
  • Phone: 320-258-3915
  • Fax: 320-258-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2618
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: