Provider Demographics
NPI:1891535993
Name:PANNING, EMMA (OD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:PANNING
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 1:101 MAIN ST S STE 103105
Mailing Address - Street 2:
Mailing Address - City:LE SUEUR
Mailing Address - State:MN
Mailing Address - Zip Code:56058-7502
Mailing Address - Country:US
Mailing Address - Phone:507-665-3366
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN ST S STE 103105
Practice Address - Street 2:
Practice Address - City:LE SUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-7502
Practice Address - Country:US
Practice Address - Phone:507-665-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3923OtherSTATE OF MN O.D LIC