Individual
DR. ANTHONY CHARLES TRAVERSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
10600 OLD COUNTY ROAD 15, PLYMOUTH, MN 55441-6210
(763) 545-8850
(763) 544-1257
Mailing address
10600 OLD COUNTY ROAD 15, PLYMOUTH, MN 55441-6210
(763) 545-8850
(763) 544-1257
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
LD2933000
MN
152WC0802X
Corneal and Contact Management Optometrist
LD2933000
MN
152WP0200X
Pediatric Optometrist
LD2933000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050972800
—
MN
01
—
2202143
MEDICA
MN
01
—
417R7TR
BLUE CROSS BLUE SHIELD
MN
01
—
977521040529
PERFERRED ONE
MN
Enumeration date
09/23/2006
Last updated
12/08/2022
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