Provider Demographics
NPI:1932257284
Name:MUSLAND, ANGELA M (OD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:MUSLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:HAWKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14322 STAPLES ST NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4289
Mailing Address - Country:US
Mailing Address - Phone:763-755-9380
Mailing Address - Fax:763-755-9415
Practice Address - Street 1:1510 125TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4749
Practice Address - Country:US
Practice Address - Phone:763-755-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410003713Medicare PIN
MNVO2657Medicare UPIN