Provider Demographics
NPI:1770588840
Name:OTTENSTROER, DENNIS (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:OTTENSTROER
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 1:3930 CEDAR GROVE PKWY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1403
Mailing Address - Country:US
Mailing Address - Phone:651-454-5661
Mailing Address - Fax:651-454-5669
Practice Address - Street 1:3930 CEDAR GROVE PKWY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1403
Practice Address - Country:US
Practice Address - Phone:651-454-5661
Practice Address - Fax:651-454-5669
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN491523200Medicaid
MN0227590001Medicare NSC
MN410000113Medicare PIN