MEDICARE: DENISE RENEE KNIEFEL O.D.

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	2744000	MN
2	152WC0802X	Corneal and Contact Management Optometrist	2744000	MN
3	152WP0200X	Pediatric Optometrist	2744000	MN
4	152WS0006X	Sports Vision Optometrist	2744000	MN
5	152WX0102X	Occupational Vision Optometrist	2744000	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP29343	OTHER	MN	HEALTH PARTNERS
2	XX1901021029	OTHER	MN	PREFERRED ONE
3	123760	OTHER	MN	UCARE
4	2212026	OTHER	MN	MEDICA
5	02S60KN	OTHER	MN	BLUE CROSS BLUE SHIELD
6	858115	OTHER	MN	AMERICA'S PPO

General Provider Information

NPI Number	:	1720177108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE RENEE KNIEFEL O.D.

Provider Business Mailing Address
First Line	:	1340 DUCKWOOD DR
Second Line	:	SUITE 14
City	:	EAGAN
State	:	MN
Zip	:	55123-2324
Country	:	US
Telephone Number	:	651-452-0344
Fax Number	:	651-452-1564

Provider Business Practice Location Address
First Line	:	1340 DUCKWOOD DR
Second Line	:	SUITE 14
City	:	EAGAN
State	:	MN
Zip	:	55123-2324
Country	:	US
Telephone Number	:	651-452-0344
Fax Number	:	651-452-1564

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	09/11/2025

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