Provider Demographics
NPI:1710614219
Name:HERAIZ, CLAUDIA (OD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:HERAIZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 FLYING CLOUD DR STE 1296
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5530
Mailing Address - Country:US
Mailing Address - Phone:802-760-9618
Mailing Address - Fax:
Practice Address - Street 1:8251 FLYING CLOUD DRIVE
Practice Address - Street 2:SUITE 1296
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-944-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3983-35152W00000X
MN3810152W00000X
MI4901005762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist