Provider Demographics
NPI:1558350207
Name:DOEDEN, GINA MARIE (OD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:DOEDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9801 DUPONT S AVE 425
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3873
Mailing Address - Country:US
Mailing Address - Phone:952-888-5800
Mailing Address - Fax:952-567-6156
Practice Address - Street 1:9801 DUPONT AVE S
Practice Address - Street 2:200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-567-6156
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2854152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN961571032480OtherPREFERRED 1 COMM HEALTH
MNU93223Medicare UPIN
MN111314OtherPATIENT CHOICE
MN2201884OtherMEDICA CHOICE
MNN007OtherTRICARE
MN0725060001OtherDMERC
MN246J0DOOtherBCBS OF MN
MN1032480OtherPREFERRED ONE
MN2201884OtherSELECT CARE
MN7757458OtherAETNA
MN230767606OtherVSP
410001906Medicare PIN
MN595809OtherARAZ/TPA/DEFINITY
MN132212OtherUCARE FOR SENIORS
MNHP37286OtherHEALTHPARTNERS
P00129890OtherRAILROAD MEDICARE