Provider Demographics
NPI:1114994589
Name:GULLINGSRUD, EUGENE O (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:O
Last Name:GULLINGSRUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-541-2800
Mailing Address - Fax:952-886-7015
Practice Address - Street 1:10709 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5509
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-567-6156
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37798207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110146OtherPATIENT CHOICE
MN15R81GUOtherBLUE CROSS BLUE SHIELD
MN0800014OtherMEDICA DUEL SOLUTIONS
MN772975OtherAMERICA'S PPO/TPA
MN0811677OtherMEDICA
MN960561016572OtherPREFERREDONE
MNF83797OtherHEALTHPARTNERS
MN15R81GUOtherBLUE CROSS BLUE SHIELD