Provider Demographics
NPI:1649323320
Name:STEVEN P CONSOER
Entity type:Organization
Organization Name:STEVEN P CONSOER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSSMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-884-8338
Mailing Address - Street 1:1731 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3372
Mailing Address - Country:US
Mailing Address - Phone:952-445-5600
Mailing Address - Fax:952-445-5629
Practice Address - Street 1:1731 17TH AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3372
Practice Address - Country:US
Practice Address - Phone:952-445-5600
Practice Address - Fax:952-445-5629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN P CONSOER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0645310003Medicare NSC
MN410033024Medicare PIN