Provider Demographics
NPI:1720066582
Name:STENSRUD, DEAN W (OD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:W
Last Name:STENSRUD
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 1:8401 GOLDEN VALLEY RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4486
Mailing Address - Country:US
Mailing Address - Phone:763-383-4130
Mailing Address - Fax:763-383-4147
Practice Address - Street 1:3366 OAKDALE AVE N
Practice Address - Street 2:SUITE 402
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-416-7600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39749Medicare UPIN