Individual
ELIZABETH A ROBERTS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4750 WASHINGTON SQ, WHITE BEAR LAKE, MN 55110-3257
(651) 429-3379
(651) 429-8681
Mailing address
4750 WASHINGTON SQ, WHITE BEAR LAKE, MN 55110-3257
(651) 429-3379
(651) 429-8681
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2553
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010370
PREFERRED ONE
MN
01
—
110387
UCARE
MN
01
—
2201001
MEDICA
MN
01
—
4C748RO
BLUE CROSS BLUE SHIELD
MN
01
—
HP19487
HEALTH PARTNERS
MN
Enumeration date
05/17/2006
Last updated
07/08/2007
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