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General NPI Number Information
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NPI Number | 1225361066
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Entity Type | Individual
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Provider Name | CHAD THEODORE BOGREN O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 1099 HELMO AVE N STE 150
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City | OAKDALE
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State | MN
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Zip | 55128-6038
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Country | US
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Telephone | 651-739-3937
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Fax | 651-739-9690
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Provider Business Mailing Address
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Address Line | 3201 ATWOOD CT
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City | STILLWATER
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State | MN
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Zip | 55082-6692
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Country | US
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Telephone | 651-439-2909
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Fax | 651-351-3978
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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 | 3169
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 3169
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 3169
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License Number State | MN
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