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Contact Information

NORTHWEST EYE CLINIC, LLC
12000 ELM CREEK BLVD N STE 100
MAPLE GROVE, MN55369-7074
 Phone: 763-416-7600
 Fax: 763-416-7634
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Ophthalmology

207W00000X 18 Physician/Ophthalmology
Indicates primary specialty

NPI Profile & details for NORTHWEST EYE CLINIC LLC · (Female)

NPI Number 1164508917
Status Active
Credentials
Entity Individual
Enumeration date 10/27/2006
Last updated 03/18/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • MN License # 360
  • MN Medicaid 221967100
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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