Provider Demographics
NPI:1043354186
Name:IMI'S MN INC
Entity Type:Organization
Organization Name:IMI'S MN 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 1:12577 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1938
Mailing Address - Country:US
Mailing Address - Phone:952-546-4414
Mailing Address - Fax:952-541-0831
Practice Address - Street 1:406 ROSEDALE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3009
Practice Address - Country:US
Practice Address - Phone:651-631-9394
Practice Address - Fax:651-631-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN745262400Medicaid
MNMN1889OtherEYEMED
2116828OtherMEDICA
MN181945OtherU CARE