Basic Information
| Provider Information | |||||||||
| NPI: | 1093823122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROYAL | ||||||||
| FirstName: | RENE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10000 ZANE AVE N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554431400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635696250 | ||||||||
| FaxNumber: | 7635696217 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 ZANE AVE N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554431400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725710 | ||||||||
| FaxNumber: | 7635696200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2498 | MN | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 127812 | 01 | MN | UCARE MN | OTHER | 2200685 | 01 | MN | MEDICA | OTHER | 1014767 | 01 | MN | AMERICA'S PPO | OTHER | 1024532 | 01 | MN | PREFERRED ONE | OTHER | 057217900 | 05 | MN | MEDICAID | HP30733 | 01 | MN | HEALTHPARTNERS | OTHER | 5857755 | 01 | MN | AETNA INS | OTHER | 87D48RO | 01 | MN | BCBS OF MN | OTHER |