Provider Demographics
NPI:1114258936
Name:IMIS MN INC
Entity Type:Organization
Organization Name:IMIS 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 1:1270 PROMENADE PL
Practice Address - Street 2:SUITE 120
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2299
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:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier