Provider Demographics
NPI:1548266273
Name:COLBY, DIRK S (OD)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:S
Last Name:COLBY
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 1:5851 DULUTH ST
Mailing Address - Street 2:STE 215
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3956
Mailing Address - Country:US
Mailing Address - Phone:763-546-8422
Mailing Address - Fax:763-546-8114
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:STE 215
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3956
Practice Address - Country:US
Practice Address - Phone:763-546-8422
Practice Address - Fax:763-546-8114
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2668152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410042866OtherRAILROAD MEDICARE
MN2200705OtherMEDICA CHOICE
MN013537200Medicaid
MN69Q24COOtherBCBS OF MN
MN410001415Medicare PIN
MN69Q24COOtherBCBS OF MN