Provider Demographics
NPI:1508046756
Name:STEVEN P CONSOER
Entity Type:Organization
Organization Name:STEVEN P CONSOER
Other - Org Name:OXBORO EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSSMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-884-8338
Mailing Address - Street 1:9721 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4232
Mailing Address - Country:US
Mailing Address - Phone:952-884-8338
Mailing Address - Fax:952-884-4599
Practice Address - Street 1:9721 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4232
Practice Address - Country:US
Practice Address - Phone:952-884-8338
Practice Address - Fax:952-884-4599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN P CONSOER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0645310001Medicare NSC
MN410025096Medicare PIN