Provider Demographics
NPI:1770546806
Name:NORDIN, ALEISHA JOO (OD)
Entity type:Individual
Prefix:DR
First Name:ALEISHA
Middle Name:JOO
Last Name:NORDIN
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 1:256 JOHNSON PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6410
Mailing Address - Country:US
Mailing Address - Phone:651-226-7407
Mailing Address - Fax:
Practice Address - Street 1:256 JOHNSON PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6410
Practice Address - Country:US
Practice Address - Phone:651-226-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03839Medicare PIN
MNV01095Medicare UPIN
MN410002368Medicare ID - Type Unspecified