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Contact Information

PARK NICOLLET HEALTH CARE PRODUCTS
EYE CARE AND OPTICAL STORE
3900 PARK NICOLLET BLVD STE 120
SAINT LOUIS PARK, MN55416-2503
 Phone: 952-993-3150
 Fax: 952-993-0562
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for PARK NICOLLET HEALTH CARE PRODUCTS

NPI Number 1609838614
LBN Legal business name PARK NICOLLET HEALTH CARE PRODUCTS
Authorized official KRISTIN BREY - (DELEGATED OFFICIAL)
Entity Organization
Organization subpart 1 Yes
Enumeration date 04/05/2006
Last updated 09/24/2025 - About 8 months ago
Identifiers
MN Medicaid 21398500
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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