Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2300 | MN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2300 | MN |
NPI | 1154468890 |
---|---|
Provider Name | Germaine E Cheslock |
First Address | Bemidji, MN 56601-5114 |
Second Address | Bemidji, MN 56601-5114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1011212 | PREFERREDONE (01) | |
2204340 | MEDICA (01) | |
28642 | ND BCBS (01) | ND |
571725600 | (05) | MN |
942G7CH | MN BCBS (01) | MN |
HP57666 | HEALTHPARTNERS (01) | |
U45836 | (02) | MN |