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General NPI Number Information
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NPI Number | 1235282633
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Entity Type | Organization
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Legal Business Name | OAKDALE OPTICAL
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7013 10TH ST N
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City | OAKDALE
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State | MN
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Zip | 55128-5938
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Country | US
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Telephone | 651-738-8040
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Fax | 651-714-0759
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Provider Business Mailing Address
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Address Line | 7013 10TH ST N
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City | OAKDALE
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State | MN
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Zip | 55128-5938
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Country | US
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Telephone | 651-738-8040
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Fax | 651-714-0759
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Authorized Official
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Title or Position | OWNER
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Name | JOHN M ELVERUM
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Credential | OD
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Telephone | 651-738-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1460
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License Number State | MN
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