Provider Demographics
NPI:1518037563
Name:MATTSON, ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:MATTSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18160 LANSFORD PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4956
Mailing Address - Country:US
Mailing Address - Phone:952-212-0131
Mailing Address - Fax:
Practice Address - Street 1:17690 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9764
Practice Address - Country:US
Practice Address - Phone:952-898-9588
Practice Address - Fax:952-898-2030
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD 2823000152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-03175OtherUNITED HEALTH CARE
MN176625200Medicaid
MN202779692OtherAETNA
MN22-03175OtherMEDICA
MN500R7MAOtherBLUE CROSS BLUE SHIELD MN
MNHP36326OtherHEALTH PARTNERS
MN79G34LAOtherBLUE PLUS
MN202779692OtherWASSAU BENEFITS PC CBSA
MNA61971031584OtherPREFERRED ONE
MN500R7MAOtherBLUE CROSS BLUE SHIELD MN
MN79G34LAOtherBLUE PLUS