Provider Demographics
NPI:1003961327
Name:DINKYTOWN OPTICAL
Entity Type:Organization
Organization Name:DINKYTOWN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-331-7100
Mailing Address - Street 1:1304 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2029
Mailing Address - Country:US
Mailing Address - Phone:612-331-7100
Mailing Address - Fax:612-331-7100
Practice Address - Street 1:1304 4TH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2029
Practice Address - Country:US
Practice Address - Phone:612-331-7100
Practice Address - Fax:612-331-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13307PAOtherBCBS OF MN
MN1001127OtherPREFERRED ONE