MEDICARE: DR. DENNIS OTTENSTROER 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
1	152W00000X	Optometrist	1558	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1770588840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS OTTENSTROER OD

Provider Business Mailing Address
First Line	:	3930 CEDAR GROVE PKWY
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1403
Country	:	US
Telephone Number	:	651-454-5661
Fax Number	:	651-454-5669

Provider Business Practice Location Address
First Line	:	3930 CEDAR GROVE PKWY
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1403
Country	:	US
Telephone Number	:	651-454-5661
Fax Number	:	651-454-5669

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/30/2008

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