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General NPI Number Information
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NPI Number | 1508046756
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Entity Type | Organization
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Legal Business Name | STEVEN P CONSOER
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 9721 LYNDALE AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-4232
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Country | US
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Telephone | 952-884-8338
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Fax | 952-884-4599
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Provider Business Mailing Address
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Address Line | 9721 LYNDALE AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-4232
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Country | US
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Telephone | 952-884-8338
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Fax | 952-884-4599
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Authorized Official
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Title or Position | MGR
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Name | MS. CHRIS OSSMO
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Credential |
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Telephone | 952-884-8338
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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 | 1764
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License Number State | MN
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