Provider Demographics
NPI:1164092383
Name:AKSOY, KATIE (OD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:AKSOY
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 1:8639 COUNTY ROAD 16 SE
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8134
Mailing Address - Country:US
Mailing Address - Phone:612-709-8661
Mailing Address - Fax:
Practice Address - Street 1:3835 W OLD SHAKOPEE RD STE 200
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3570
Practice Address - Country:US
Practice Address - Phone:651-461-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist