Provider Demographics
NPI:1538276258
Name:EXSTED, STEVEN TODD (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:TODD
Last Name:EXSTED
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3567 144TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-6247
Mailing Address - Country:US
Mailing Address - Phone:763-295-9817
Mailing Address - Fax:
Practice Address - Street 1:9320 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4522
Practice Address - Country:US
Practice Address - Phone:763-295-9817
Practice Address - Fax:763-295-9819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist