Provider Demographics
NPI:1164438156
Name:RISTAD, DONALD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALLEN
Last Name:RISTAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3939 W 50TH ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1244
Mailing Address - Country:US
Mailing Address - Phone:952-920-2020
Mailing Address - Fax:952-920-3225
Practice Address - Street 1:3939 W 50TH ST
Practice Address - Street 2:STE. 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1244
Practice Address - Country:US
Practice Address - Phone:952-920-2020
Practice Address - Fax:952-920-3225
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN25476207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN219792800Medicaid
MN219792800Medicaid
A96335Medicare UPIN