Healthcare Provider Details

I. General information

NPI: 1952500951
Provider Name (Legal Business Name): HEIDI NOEL SKONSENG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI NOEL WELTON

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 HIGHWAY 7
ST LOUIS PARK MN
55426-3919
US

IV. Provider business mailing address

11182 MEG GRACE LN
EDEN PRAIRIE MN
55344-7853
US

V. Phone/Fax

Practice location:
  • Phone: 952-933-4858
  • Fax:
Mailing address:
  • Phone: 713-823-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3097
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: