Provider Demographics
NPI:1710214432
Name:MAIRS KNIPPLE, CASSIE (OD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:MAIRS KNIPPLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:MAIRS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1665
Practice Address - Country:US
Practice Address - Phone:800-952-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3338ATI152W00000X
MN3190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist