Individual
DR. MAUREEN WHELAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1900 DIVISION ST W, BEMIDJI, MN 56601-6396
(218) 759-1430
(218) 444-9086
Mailing address
1900 DIVISION ST W, BEMIDJI, MN 56601-6396
(218) 759-1430
(218) 444-9086
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2110
MN
152W00000X
Optometrist
2154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2200103
MEDICA
MN
01
—
4C014WH
BCBS
MN
01
—
4C957WH
BCBS NON PAR
MN
05
—
548523100
—
MN
01
—
DD9612
RR MEDICARE
MN
Enumeration date
01/02/2007
Last updated
12/15/2014
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