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Contact Information

MINNESOTA EYE CONSULTANTS, PA
1965 11TH AVE E
SUITE 102
MAPLEWOOD, MN55109-5167
 Phone: 952-888-5800
 Fax: 651-748-4445
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Ophthalmology

207W00000X 18 Physician/Ophthalmology
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
 

Corneal and Contact Management

152WC0802X 41 Optometry
 

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for MINNESOTA EYE CONSULTANTS, PA

NPI Number 1861465064
LBN Legal business name MINNESOTA EYE CONSULTANTS, PA
Authorized official BRENT WILDE - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 02/08/2006
Last updated 02/22/2017 - About 9 years ago
Identifiers
MN License # 24D2023181
MN Medicaid 680090400
MN Other 24D2023181 CLIA
MN Other CG8516 RR MEDICARE GROUP NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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