Provider Demographics
NPI:1700847035
Name:COLE, TRENT D (OD)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:D
Last Name:COLE
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:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-0171
Mailing Address - Country:US
Mailing Address - Phone:763-242-1882
Mailing Address - Fax:
Practice Address - Street 1:7011 10TH ST N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5938
Practice Address - Country:US
Practice Address - Phone:651-738-8040
Practice Address - Fax:651-714-0759
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN086632000Medicaid
MN086632000Medicaid
MN410002786Medicare PIN