Individual
ALYSON L BLAKSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
10709 WAYZATA BLVD STE 200, MINNETONKA, MN 55305-5509
(952) 888-5800
(952) 567-6156
Mailing address
9801 DUPONT AVE S, SUITE 425, BLOOMINGTON, MN 55431-3100
(952) 567-6092
(952) 567-6176
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
2673
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293663100
—
MN
01
—
410045931
MEDICARE RAILROAD
MN
Enumeration date
09/14/2005
Last updated
09/15/2020
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