Basic Information
| Provider Information | |||||||||
| NPI: | 1285619684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAKES | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE S # MS 21110Q | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 BLAISDELL AVE | ||||||||
| Address2: | PARK NICOLLET CLINIC-MINNEAPOLIS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554042414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938000 | ||||||||
| FaxNumber: | 9529938039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 27963 | MN | N | Eye and Vision Services Providers | Optometrist | 207WX0200X | 27963 | MN | Y |
No ID Information.