Provider Demographics
NPI:1952407637
Name:CARDINAL, PAUL W (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:CARDINAL
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 1:144 TYLER RD N STE B
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1889
Mailing Address - Country:US
Mailing Address - Phone:651-388-3838
Mailing Address - Fax:
Practice Address - Street 1:144 TYLER RD N STE B
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1889
Practice Address - Country:US
Practice Address - Phone:651-388-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C733PEOtherBLUE CROSS BLUE SHIELD
MN2120197OtherMEDICA
MN31700OtherHEALTHPARTNERS
MN557323800OtherMN CARE
MN921871021773OtherPREFERRED ONE
MN010306OtherEYEMED
MN131060OtherUCARE
MN131060OtherUCARE
MN31700OtherHEALTHPARTNERS