Provider Demographics
NPI:1417940644
Name:GILTHVEDT, ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:GILTHVEDT
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 1:118 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2311
Mailing Address - Country:US
Mailing Address - Phone:507-451-3072
Mailing Address - Fax:507-451-4291
Practice Address - Street 1:118 N OAK AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2311
Practice Address - Country:US
Practice Address - Phone:507-451-3072
Practice Address - Fax:507-451-4291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP20985OtherHEALTH PARTNERS
2200937OtherMEDICA
1011308OtherPREFERRED ONE
MN122239OtherU-CARE
59829GIOtherBLUECROSS BLUESHIELD
2200937OtherMEDICA