Provider Demographics
NPI:1760968895
Name:SHIPITALO, MARGARET MARY (OD, MS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:SHIPITALO
Suffix:
Gender:F
Credentials:OD, MS
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Other - First Name:
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Mailing Address - Street 1:6099 WAYZATA BLVD STE 100-120
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5538
Mailing Address - Country:US
Mailing Address - Phone:952-204-5060
Mailing Address - Fax:952-204-9060
Practice Address - Street 1:6099 WAYZATA BLVD STE 100-120
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5538
Practice Address - Country:US
Practice Address - Phone:952-204-5060
Practice Address - Fax:952-204-9060
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHOPT.006635152W00000X
MN3646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist