Provider Demographics
NPI:1982792867
Name:OSNES, RUSSELL NATHANIEL (OD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:NATHANIEL
Last Name:OSNES
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 1:1340 DUCKWOOD DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2324
Mailing Address - Country:US
Mailing Address - Phone:651-452-0344
Mailing Address - Fax:651-452-1564
Practice Address - Street 1:1340 DUCKWOOD DR
Practice Address - Street 2:SUITE 14
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2324
Practice Address - Country:US
Practice Address - Phone:651-452-0344
Practice Address - Fax:651-452-1564
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1958000152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2204496OtherMEDICA
MN103669OtherUCARE
MN867223700Medicaid
MN2200456OtherMEDICA
MN867223700Medicaid
MN2204496OtherMEDICA
MN103669OtherUCARE
MN410001225Medicare ID - Type Unspecified