Provider Demographics
NPI:1801807292
Name:KOLLES, BERTRAND A (OD)
Entity type:Individual
Prefix:DR
First Name:BERTRAND
Middle Name:A
Last Name:KOLLES
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 1:1011 N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2662
Mailing Address - Country:US
Mailing Address - Phone:651-437-5469
Mailing Address - Fax:651-437-2910
Practice Address - Street 1:1011 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2662
Practice Address - Country:US
Practice Address - Phone:651-437-5469
Practice Address - Fax:651-437-2910
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39796Medicare UPIN