Provider Demographics
NPI:1881680056
Name:AKRE, STEPHEN P (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:AKRE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1715 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3751
Mailing Address - Country:US
Mailing Address - Phone:507-354-8531
Mailing Address - Fax:507-359-1124
Practice Address - Street 1:1715 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3751
Practice Address - Country:US
Practice Address - Phone:507-354-8531
Practice Address - Fax:507-359-1124
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1022216OtherPREFERRED ONE
MN4C730AKOtherBLUE CROSS/BLUE SHIELD MN
MN114238OtherUCARE
MN2210211OtherMEDICA
MNHP18369OtherHEALTHPARTNERS
MN4C730AKOtherBLUE CROSS/BLUE SHIELD MN