Provider Demographics
NPI:1588615413
Name:CASPERS, ALLYSON K (OD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:K
Last Name:CASPERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WASHINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3257
Mailing Address - Country:US
Mailing Address - Phone:651-429-3379
Mailing Address - Fax:651-429-8681
Practice Address - Street 1:4750 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3257
Practice Address - Country:US
Practice Address - Phone:651-429-3379
Practice Address - Fax:651-429-8681
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN626718100Medicaid
MNHP20333OtherHEALTH PARTNERS
MN114056OtherUCARE
MN1011968OtherPREFERRED ONE
MN2202806OtherMEDICA
MN147L5CAOtherBLUE CROSS BLUE SHIELD
MN1011968OtherPREFERRED ONE
MN147L5CAOtherBLUE CROSS BLUE SHIELD
410002019Medicare ID - Type Unspecified