Individual
CHARLES R MEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
LD1642000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107964
UCARE MN
MN
01
—
110992
PATIENT CHOICE
MN
05
—
123023900
—
MN
01
—
21-15729
MEDICA MATERIALS
MN
01
—
2202721
MEDICA
MN
01
—
25841ME
BLUE CROSS BLUE SHIELD
MN
01
—
410038747
RAILROAD MEDICARE
MN
01
—
580610207
MEDICARE ID
MN
01
—
622001
PREFERRED ONE
MN
Enumeration date
07/20/2006
Last updated
02/23/2016
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