Organization
CHARLES R MEAD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY MEAD (PRACTICE MANAGER)
(651) 735-9550
Entity
Organization
Contact information
Practice address
1502 WOODLANE DR, WOODBURY, MN 55125-2221
(651) 735-9550
(651) 735-9322
Mailing address
1502 WOODLANE DR, WOODBURY, MN 55125-2221
(651) 735-9550
(651) 735-9322
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
156FX1202X
Optometric Technician
—
—
156FX1800X
Optician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25841ME
BLUE CROSS BLUE SHIELD
MN
05
—
568938300
—
MN
01
—
97365062201
PREFERREDONE
MN
Enumeration date
04/05/2010
Last updated
04/02/2018
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