1154327757 NPI number — DR. PAUL J SHLAFER O.D.

Table of content: DR. PAUL J SHLAFER O.D. (NPI 1154327757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154327757 NPI number — DR. PAUL J SHLAFER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHLAFER
Provider First Name:
PAUL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHLAEFER
Provider Other First Name:
PAUL
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154327757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 HAZELTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-926-5300
Provider Business Mailing Address Fax Number:
952-926-2729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 HAZELTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-926-5300
Provider Business Practice Location Address Fax Number:
952-926-2729
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  MN1963 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11986 . This is a "COLE MANAGED VISION CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 84414SH . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 23746 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 540825300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MN1963 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: SH1426016 . This is a "CLARITY VISION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22-20252 . This is a "MEDICA /UNITED HEALTHCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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