Provider Demographics
NPI:1336719475
Name:MINNERATH, SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MINNERATH
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 1:6874 COUNTY ROAD 28 SW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-6018
Mailing Address - Country:US
Mailing Address - Phone:320-760-3018
Mailing Address - Fax:
Practice Address - Street 1:2210 HIGHWAY 29 S STE 201
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3500
Practice Address - Country:US
Practice Address - Phone:320-219-6543
Practice Address - Fax:320-219-6545
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist