Provider Demographics
NPI:1649963752
Name:ST ORES, CAROLINE PAIGE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PAIGE
Last Name:ST ORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7872 MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9440
Mailing Address - Country:US
Mailing Address - Phone:952-934-1424
Mailing Address - Fax:
Practice Address - Street 1:7872 MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9440
Practice Address - Country:US
Practice Address - Phone:952-934-1424
Practice Address - Fax:952-934-2140
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist