Provider Demographics
NPI:1033394077
Name:EYE 35 OPTOMETRISTS, LTD.
Entity Type:Organization
Organization Name:EYE 35 OPTOMETRISTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-435-3505
Mailing Address - Street 1:18488 KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6911
Mailing Address - Country:US
Mailing Address - Phone:952-435-3505
Mailing Address - Fax:
Practice Address - Street 1:18488 KENYON AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6911
Practice Address - Country:US
Practice Address - Phone:952-435-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN379652300Medicaid
MN379652300Medicaid
MNT90872Medicare UPIN