Provider Demographics
NPI:1962450627
Name:BIETER, JEFFREY M (OS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:BIETER
Suffix:
Gender:M
Credentials:OS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8617 W POINT DOUGLAS RD S
Mailing Address - Street 2:#110
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4145
Mailing Address - Country:US
Mailing Address - Phone:651-769-1020
Mailing Address - Fax:651-769-1021
Practice Address - Street 1:8617 W POINT DOUGLAS RD S
Practice Address - Street 2:#110
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4145
Practice Address - Country:US
Practice Address - Phone:651-769-1020
Practice Address - Fax:651-769-1021
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU51210Medicare UPIN