Provider Demographics
NPI:1811939838
Name:STOLTMAN, WARREN J (OD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:J
Last Name:STOLTMAN
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 1:103 CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2957
Mailing Address - Country:US
Mailing Address - Phone:763-682-1282
Mailing Address - Fax:
Practice Address - Street 1:103 CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2957
Practice Address - Country:US
Practice Address - Phone:763-682-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU95693Medicare UPIN
MN410001995Medicare ID - Type Unspecified