Provider Demographics
NPI:1225361066
Name:BOGREN, CHAD THEODORE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:THEODORE
Last Name:BOGREN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 ATWOOD CT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6692
Mailing Address - Country:US
Mailing Address - Phone:651-439-2909
Mailing Address - Fax:651-351-3978
Practice Address - Street 1:1099 HELMO AVE N
Practice Address - Street 2:STE 150
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6038
Practice Address - Country:US
Practice Address - Phone:651-739-3937
Practice Address - Fax:651-739-9690
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3169152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation