Provider Demographics
NPI:1396319968
Name:HARESDIN, MEGAN (OD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HARESDIN
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 1:7789 147TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7568
Mailing Address - Country:US
Mailing Address - Phone:952-432-0680
Mailing Address - Fax:
Practice Address - Street 1:1202 MOORE LAKE DR E
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5170
Practice Address - Country:US
Practice Address - Phone:763-574-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist