Provider Demographics
NPI:1659360436
Name:MCDONALD, ANTHONY MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-0847
Mailing Address - Country:US
Mailing Address - Phone:952-469-3937
Mailing Address - Fax:877-795-9884
Practice Address - Street 1:20094 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5404
Practice Address - Country:US
Practice Address - Phone:952-469-3937
Practice Address - Fax:877-795-9884
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1916152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN101851OtherUCARE FOR SENIORS
MN111314OtherPATIENT CHOICE
MNHP15243OtherHEALTHPARTNERS
MN6950001OtherPREFERRED ONE
1103802OtherUNITED HEALTHCARE
410002188OtherRAILROAD MEDICARE
MN4303789OtherAETNA
MN2204924OtherSELECT CARE
MN56419MCOtherBCBS OF MN
MN0725060001OtherDMERC
MN2204924OtherMEDICA CHOICE
MNN007OtherTRICARE
MN595809OtherARAZ/TPA/DEFINITY
MN961570695001OtherPREFERRED 1 COMM HEALTH
MN2204924OtherMEDICA CHOICE
MNT39830Medicare UPIN