Provider Demographics
NPI:1780800904
Name:STRATEGIC PRACTICE MANAGEMENT, P.A.
Entity type:Organization
Organization Name:STRATEGIC PRACTICE MANAGEMENT, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-738-8040
Mailing Address - Street 1:7011 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5938
Mailing Address - Country:US
Mailing Address - Phone:651-738-8040
Mailing Address - Fax:651-714-0759
Practice Address - Street 1:7011 10TH ST N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5938
Practice Address - Country:US
Practice Address - Phone:651-738-8040
Practice Address - Fax:651-714-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN086632000Medicaid
MN6033130001Medicare NSC