Provider Demographics
NPI:1093027112
Name:SUNDELL EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:SUNDELL EYE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-741-4411
Mailing Address - Street 1:602 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2339
Mailing Address - Country:US
Mailing Address - Phone:218-741-4411
Mailing Address - Fax:218-741-8966
Practice Address - Street 1:602 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2339
Practice Address - Country:US
Practice Address - Phone:218-741-4411
Practice Address - Fax:218-741-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty