Basic Information
| Provider Information | |||||||||
| NPI: | 1649323320 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEVEN P CONSOER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SHAKOPEE VISION CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1731 17TH AVE E | ||||||||
| Address2: | |||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553793372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524455600 | ||||||||
| FaxNumber: | 9524455629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1731 17TH AVE E | ||||||||
| Address2: | |||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553793372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524455600 | ||||||||
| FaxNumber: | 9524455629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | OSSMO | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9528848338 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STEVEN P CONSOER | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1764 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.