Provider Demographics
NPI:1902850852
Name:TRUDEL, TODD E (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:TRUDEL
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 1:870 PRENTICE ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-1521
Mailing Address - Country:US
Mailing Address - Phone:320-564-4997
Mailing Address - Fax:320-564-2020
Practice Address - Street 1:870 PRENTICE ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1521
Practice Address - Country:US
Practice Address - Phone:320-564-4997
Practice Address - Fax:320-564-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN790825300Medicaid
MN410002193Medicare PIN
MNU13386Medicare UPIN
MN790825300Medicaid