1720056641 NPI number — DR. EDWARD AUGDAHL O.D.

Table of content: MS. JOANNA KARATHOMAS M.S CCC-A (NPI 1053355800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720056641 NPI number — DR. EDWARD AUGDAHL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUGDAHL
Provider First Name:
EDWARD
Provider Middle Name:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720056641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5515 XERXES AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55430-2856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-560-1636
Provider Business Mailing Address Fax Number:
763-560-4101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEARLE VISION
Provider Second Line Business Practice Location Address:
5515 XERXES AVE NORTH
Provider Business Practice Location Address City Name:
BROOKLYN CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-560-1636
Provider Business Practice Location Address Fax Number:
763-560-4101
Provider Enumeration Date:
03/08/2006

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:  MN2571 , 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: 296N0AU . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2203101 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 781138100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MN2571 . This is a "EYEMED" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 24F55PE . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 513T1PE . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1720056641 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2260985 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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