Provider Demographics
NPI:1518975275
Name:CONSOER, STEVEN PETER (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PETER
Last Name:CONSOER
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 1:1731 17TH AVE E
Mailing Address - Street 2:SHAKOPEE VISION CLINIC
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3372
Mailing Address - Country:US
Mailing Address - Phone:952-445-5600
Mailing Address - Fax:952-445-5629
Practice Address - Street 1:1731 17TH AVE E
Practice Address - Street 2:SHAKOPEE VISION CLINIC
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3372
Practice Address - Country:US
Practice Address - Phone:952-445-5600
Practice Address - Fax:952-445-5629
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2214561OtherMEDICA
MN315823300Medicaid
MN0G498COOtherBCBS
MN0G498COOtherBCBS
MN0G498COOtherBCBS
MC1104239OtherDEA