1255320289 NPI number — ANDERSON & MCDONALD OD LTD

Table of content: (NPI 1255320289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255320289 NPI number — ANDERSON & MCDONALD OD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON & MCDONALD OD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCDONALD EYE CARE ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1255320289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55044-0847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-469-3937
Provider Business Mailing Address Fax Number:
952-469-2132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20094 KENWOOD TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-469-3937
Provider Business Practice Location Address Fax Number:
877-795-9884
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
952-469-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  13 , 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: 5056693 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22-00002 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2304933 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DB8139 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP17629 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56091AN . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 102350 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".




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