Marta Bakouris
Individual provider Active NPI Optometrist · Woodbury, MN
NPI 1487962478 · NPPES record last updated Nov 23, 2011
Key facts
- NPI
- 1487962478
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3213 (MN)
- Practice address
- 9965 Hudson PL
Woodbury, MN 55125-9401 - Phone
- (612) 252-0047
- NPI assigned
- Sep 23, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3213 | MN | MD | Marriage & Family Therapist |
| 2787 | CO | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2787 | CO | |
| Optometrist | 152W00000X | 3213 | MN | Yes |
Addresses
Primary practice location
9965 Hudson PL
Woodbury, MN 55125-9401
Mailing address
9965 Hudson PL
Woodbury, MN 55125-9401
Phone (612) 252-0047
Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.