Provider Demographics
NPI:1255326401
Name:HARTER, DEANNA E (OD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:E
Last Name:HARTER
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 1:3939 W 50TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1285
Mailing Address - Country:US
Mailing Address - Phone:952-920-2020
Mailing Address - Fax:952-920-3225
Practice Address - Street 1:3939 W 50TH ST STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424
Practice Address - Country:US
Practice Address - Phone:952-920-2020
Practice Address - Fax:952-920-3225
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2737152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN706822100Medicaid
MN706822100Medicaid
MN410001308Medicare PIN