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General NPI Number Information
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NPI Number | 1104975762
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Entity Type | Individual
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Provider Name | CHAD R. DOCKTER OD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | TARGET OPTICAL 8225 FLYING CLOUD DRIVE
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344
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Country | US
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Telephone | 952-563-0247
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 WHITE OAK DR.
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City | CHASKA
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State | MN
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Zip | 55318
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Country | US
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Telephone | 952-466-3937
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Fax | 952-466-3936
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2439
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License Number State | MN
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