Provider Demographics
NPI:1720177108
Name:KNIEFEL, DENISE RENEE (OD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:KNIEFEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 DUCKWOOD DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2324
Mailing Address - Country:US
Mailing Address - Phone:651-452-0344
Mailing Address - Fax:651-452-1564
Practice Address - Street 1:1340 DUCKWOOD DR
Practice Address - Street 2:SUITE 14
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2324
Practice Address - Country:US
Practice Address - Phone:651-452-0344
Practice Address - Fax:651-452-1564
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2744000152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP29343OtherHEALTH PARTNERS
MNXX1901021029OtherPREFERRED ONE
MN123760OtherUCARE
MN2212026OtherMEDICA
MN02S60KNOtherBLUE CROSS BLUE SHIELD
MN858115OtherAMERICA'S PPO
MN858115OtherAMERICA'S PPO
MNXX1901021029OtherPREFERRED ONE