MEDICARE: VIVIAN PASTRANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4068	MN

General Provider Information

NPI Number	:	1023935301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN PASTRANA

Provider Business Mailing Address
First Line	:	5844 THOMAS AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 PENN AVE S
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-1143
Country	:	US
Telephone Number	:	305-775-1505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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Directions to “ VIVIAN PASTRANA ” Practice Location

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