Traverse, Anthony Charles
Traverse, Anthony Charles is an individual health care provider with primary practice located at 10600 Old County Road 15 , Plymouth MN 55441-6210. He recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Pediatrics. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Traverse, Anthony Charles can be contacted via phone (763) 545-8850.Contact Information
Primary practice address
10600 Old County Road 15
Plymouth MN 55441-6210
Phone: (763) 545-8850
Fax: (763) 544-1257
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | LD2933000 | Minnesota |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | LD2933000 | Minnesota |
| Eye and Vision Services Providers / Pediatrics | 152WP0200X | LD2933000 | Minnesota |
Profile Details
| NPI number | 1255431961 |
|---|---|
| LBN Legal business name | Traverse, Anthony Charles |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 23rd, 2006 |
| Last updated | Dec 8th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255431961 | NPPES |
| Minnesota | Other | 2202143 | MEDICA |
| Minnesota | MEDICAID | 050972800 | MEDICA |
| Minnesota | Other | 417R7TR | MEDICA |
| Minnesota | Other | 977521040529 | MEDICA |
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