Provider Demographics
NPI:1003507997
Name:NESTRUD, CARLEE JO (OD)
Entity Type:Individual
Prefix:
First Name:CARLEE
Middle Name:JO
Last Name:NESTRUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 GERSHWIN AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1911
Mailing Address - Country:US
Mailing Address - Phone:651-323-4927
Mailing Address - Fax:
Practice Address - Street 1:1101 1ST ST NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2197
Practice Address - Country:US
Practice Address - Phone:952-758-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist