Provider Demographics
NPI:1093823122
Name:ROYAL, RENE L (OD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:L
Last Name:ROYAL
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 1:10000 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1400
Mailing Address - Country:US
Mailing Address - Phone:763-569-6250
Mailing Address - Fax:763-569-6217
Practice Address - Street 1:10000 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1400
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-569-6200
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN127812OtherUCARE MN
MN2200685OtherMEDICA
MN1014767OtherAMERICA'S PPO
MN1024532OtherPREFERRED ONE
MN057217900Medicaid
MNHP30733OtherHEALTHPARTNERS
MN5857755OtherAETNA INS
MN87D48ROOtherBCBS OF MN
MNU51453Medicare UPIN
MN410043918Medicare ID - Type UnspecifiedRR MEDICARE
MN1024532OtherPREFERRED ONE