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General NPI Number Information
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NPI Number | 1619525458
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Entity Type | Individual
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Provider Name | CALVIN BOOTS OD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 3777 COON RAPIDS BLVD NW STE 100
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City | COON RAPIDS
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State | MN
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Zip | 55433-2630
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Country | US
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Telephone | 612-999-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 3777 COON RAPIDS BLVD NW STE 100
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City | COON RAPIDS
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State | MN
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Zip | 55433-2630
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Country | US
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Telephone | 612-999-2020
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Fax |
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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 | 18004190A
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License Number State | IN
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