Provider Demographics
NPI:1134637457
Name:DOWNTOWN EYES CROSSTOWN PLLC
Entity Type:Organization
Organization Name:DOWNTOWN EYES CROSSTOWN PLLC
Other - Org Name:DOWNTOWN EYES CROSSTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ZASTROW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-210-0469
Mailing Address - Street 1:800 NICOLLET MALL STE 260
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-7023
Mailing Address - Country:US
Mailing Address - Phone:612-333-3937
Mailing Address - Fax:612-359-0607
Practice Address - Street 1:6601 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2477
Practice Address - Country:US
Practice Address - Phone:612-869-1333
Practice Address - Fax:612-869-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3211152W00000X
207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID