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Organization
OAKDALE OPTICAL
Active
Organization
OAKDALE OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M ELVERUM OD (OWNER)
(651) 738-8040
Entity
Organization
Contact information
Practice address
7013 10TH ST N, OAKDALE, MN 55128-5938
(651) 738-8040
(651) 714-0759
Mailing address
7013 10TH ST N, OAKDALE, MN 55128-5938
(651) 738-8040
(651) 714-0759
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1460
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101869
UCARE
MN
01
—
106141
UCARE HARDWARE
MN
01
—
1C741OA
BCBS DISP
MN
01
—
2113780
MEDICA DISP
MN
01
—
2222625
MEDICA
MN
01
—
56097EL
BCBS SITE
MN
01
—
86629EL
BCBS PROVIDER
MN
Enumeration date
01/19/2007
Last updated
08/22/2020
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