Provider Demographics
NPI:1205951415
Name:RICHARD J. DANNENBERG
Entity type:Organization
Organization Name:RICHARD J. DANNENBERG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DANNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-233-3500
Mailing Address - Street 1:2023 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-3954
Mailing Address - Country:US
Mailing Address - Phone:507-233-3500
Mailing Address - Fax:507-354-7562
Practice Address - Street 1:2023 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-3954
Practice Address - Country:US
Practice Address - Phone:507-233-3500
Practice Address - Fax:507-354-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27830332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110565OtherEYEMED
MN826041022794OtherPREFERRED ONE
MN0808759OtherMEDICA
MN114683OtherU-CARE
MN5C212DAOtherBCBS BLUE PLUS
MN475067500Medicaid
MN19379OtherHEALTH PARTNERS
MN43034DAOtherBCBSMN
MN19379OtherHEALTH PARTNERS
MN0808759OtherMEDICA