Provider Demographics
NPI:1043353949
Name:I M I S MINNESOTA INC
Entity Type:Organization
Organization Name:I M I S MINNESOTA INC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-546-4414
Mailing Address - Street 1:1601 PLYMOUTH ROAD S
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-1956
Mailing Address - Country:US
Mailing Address - Phone:952-546-4414
Mailing Address - Fax:952-541-0831
Practice Address - Street 1:1601 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1956
Practice Address - Country:US
Practice Address - Phone:952-546-4414
Practice Address - Fax:952-541-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 156FC0800X, 156FC0801X
MN156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN102069OtherEYEMED
MN129315OtherU CARE