Provider Demographics
NPI:1679610125
Name:EMERSON, TAMRA GEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMRA
Middle Name:GEAN
Last Name:EMERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12 BRIDGE SQUARE
Mailing Address - Street 2:101
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2463
Mailing Address - Country:US
Mailing Address - Phone:763-421-4334
Mailing Address - Fax:763-421-4617
Practice Address - Street 1:1920 1ST AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2437
Practice Address - Country:US
Practice Address - Phone:763-427-4000
Practice Address - Fax:763-433-2609
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2C209OtherBLUE CROSS
MN2228896OtherMEDICA
MN115418OtherU CARE
MNHP19239OtherHEALTH PARTNERS
MN841825000Medicaid
MN989541008018OtherPREFERRED ONE