Provider Demographics
NPI:1982735668
Name:ELIASON, KARI LYNN (OD)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:LYNN
Last Name:ELIASON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CANAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-9684
Mailing Address - Country:US
Mailing Address - Phone:763-477-5579
Mailing Address - Fax:763-477-5579
Practice Address - Street 1:356 12TH ST SW
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1749
Practice Address - Country:US
Practice Address - Phone:651-464-1955
Practice Address - Fax:657-464-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 2795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN137J0ELOtherBLUE CROSS BLUE SHIELD
MN141664OtherUCARE
MN933591034648OtherPREFERRED ONE
MN22-02383OtherMEDICA
MN137J1ELOtherBLUE CROSS BLUE SHIELD
MN22-02072OtherMEDICA
MN22-02384OtherMEDICA
MN22-02386OtherMEDICA
MNHP39679OtherHEALTH PARTNERS
MN063M5ELOtherBLUE CROSS BLUE SHIELD
MN22-02382OtherMEDICA
MN22-02387OtherMEDICA
MN910561OtherEYEMED
MN22-02388OtherMEDICA
MN22-02072OtherMEDICA