Provider Demographics
NPI:1740474105
Name:TAMRA G EMERSON OD PA
Entity type:Organization
Organization Name:TAMRA G EMERSON OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-421-4334
Mailing Address - Street 1:12 BRIDGE SQUARE
Mailing Address - Street 2:STE 101
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303
Mailing Address - Country:US
Mailing Address - Phone:763-421-4334
Mailing Address - Fax:763-421-4617
Practice Address - Street 1:12 BRIDGE SQUARE
Practice Address - Street 2:STE 101
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:763-421-4334
Practice Address - Fax:763-421-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT91976Medicare UPIN