Provider Demographics
NPI:1952347056
Name:MJELSTAD, AARON BLAINE (OD)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:BLAINE
Last Name:MJELSTAD
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 1:228 WATER ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1825
Mailing Address - Country:US
Mailing Address - Phone:952-401-6300
Mailing Address - Fax:952-401-6303
Practice Address - Street 1:29 9TH AVE N
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8087
Practice Address - Country:US
Practice Address - Phone:952-935-2020
Practice Address - Fax:952-935-5660
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82554Medicare UPIN