Provider Demographics
NPI:1437216439
Name:WHELAN, MAUREEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:WHELAN
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 1:1900 DIVISION ST W
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6396
Mailing Address - Country:US
Mailing Address - Phone:218-759-1430
Mailing Address - Fax:218-444-9086
Practice Address - Street 1:1900 DIVISION ST W
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6396
Practice Address - Country:US
Practice Address - Phone:218-759-1430
Practice Address - Fax:218-444-9086
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2154152W00000X
MN2110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN548523100Medicaid
MNDD9612OtherRR MEDICARE
MN2200103OtherMEDICA
MN4C014WHOtherBCBS
MN4C957WHOtherBCBS NON PAR
410001230Medicare PIN
T63655Medicare UPIN
C02653Medicare PIN
MN0916440001Medicare NSC