Provider Demographics
NPI:1861493843
Name:CATAPANO, LYNETTE ROSE (OD PC)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:ROSE
Last Name:CATAPANO
Suffix:
Gender:F
Credentials:OD PC
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:ROSE
Other - Last Name:CATAPANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD PC
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:814 CLEARWATER CTR
Mailing Address - City:CLEARWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55320
Mailing Address - Country:US
Mailing Address - Phone:320-558-9403
Mailing Address - Fax:320-558-4583
Practice Address - Street 1:12 BRIDGE SQ
Practice Address - Street 2:STE 101
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2463
Practice Address - Country:US
Practice Address - Phone:320-558-9403
Practice Address - Fax:320-558-4583
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2281152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0730002OtherPREFERRED ONE
MN682225800Medicaid
MN75D85CLOtherBCBS
MN1309020001OtherDMERC
MN2211986OtherMEDICA
MN73D83VROtherBCBS
MN2211986OtherMEDICA
MNT92810Medicare UPIN
MN682225800Medicaid