Provider Demographics
NPI:1952500951
Name:SKONSENG, HEIDI NOEL (OD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:NOEL
Last Name:SKONSENG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:NOEL
Other - Last Name:WELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11182 MEG GRACE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7853
Mailing Address - Country:US
Mailing Address - Phone:713-823-1422
Mailing Address - Fax:
Practice Address - Street 1:8900 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3919
Practice Address - Country:US
Practice Address - Phone:952-933-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist