Provider Demographics
NPI:1396848206
Name:LOERZEL, REBECCA (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LOERZEL
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 1:9451 MAPLE GROVE PKWY
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-5447
Mailing Address - Country:US
Mailing Address - Phone:763-416-2312
Mailing Address - Fax:763-416-2314
Practice Address - Street 1:9451 MAPLE GROVE PKWY
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-5447
Practice Address - Country:US
Practice Address - Phone:763-416-2312
Practice Address - Fax:763-416-2314
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07567WAOtherBLUE CROSS BLUE SHIELD
MN979841032352OtherPREFERRED ONE
MN2202576OtherMEDICA
MN24022OtherSPECTERA
MN410002219Medicare ID - Type Unspecified
MN2202576OtherMEDICA