| Doctor Name: | DR. CHAD THEODORE BOGREN |
| NPI Number: | 1225361066 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | O.D. |
| License Number: | 3169 |
| Business Practice Address: | 5815 Norell Ave N Oak Park Heights, MN - 550821766 |
| Business Phone Number: | 6513513976 |
| Business Fax Number: | 6513513978 |
| Mailing Address: | 3640 Edward St Ne, ST ANTHONY |
| State: | MN |
| Postal Code: | 554181553 |
| Phone Number: | 6127880988 |
| Fax Number: | |
| NPI Enumeration Date: | 09/11/2009 |
| NPI Last Update Date: | 09/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 3169 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |