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NPI Code Detail

MEDICARE: PATRICK J WANDS OD

MEDICARE: PATRICK J WANDS OD
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
1152W00000XOptometristMN2066MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679538250
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK J WANDS OD
Provider Business Mailing Address
First Line : 10538 GRANT DR
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55347
Country : US
Telephone Number : 952-941-7480
Fax Number :
Provider Business Practice Location Address
First Line : 2024 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1931
Country : US
Telephone Number : 652-698-2020
Fax Number : 652-698-6918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2006
Last Update Date : 08/03/2020

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