Provider Demographics
NPI:1679538250
Name:WANDS, PATRICK J (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:WANDS
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 1:10538 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347
Mailing Address - Country:US
Mailing Address - Phone:952-941-7480
Mailing Address - Fax:
Practice Address - Street 1:2024 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1931
Practice Address - Country:US
Practice Address - Phone:652-698-2020
Practice Address - Fax:652-698-6918
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2066152W00000X
WI2113035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN658703800Medicaid
MN658703800Medicaid
MN410002591Medicare PIN