Provider Demographics
NPI:1528178688
Name:BRENDTRO, ERIK CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:CHRISTOPHER
Last Name:BRENDTRO
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 1:850 COUNTY ROAD E E
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7117
Mailing Address - Country:US
Mailing Address - Phone:651-486-7303
Mailing Address - Fax:651-486-7702
Practice Address - Street 1:850 COUNTY ROAD E E
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7117
Practice Address - Country:US
Practice Address - Phone:651-486-7303
Practice Address - Fax:651-486-7702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2508152W00000X
SD485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C199BROtherBLUE CROSS& BLUE SHIELD
MN22-01067OtherMEDICA HEALTH PLANS
MN22-01067OtherMEDICA HEALTH PLANS
MNU-21432Medicare UPIN