Provider Demographics
NPI:1235737990
Name:FAMILY VISION OF MINNESOTA PLLC
Entity Type:Organization
Organization Name:FAMILY VISION OF MINNESOTA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PIANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-887-6631
Mailing Address - Street 1:5817 IVY LN
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5314
Mailing Address - Country:US
Mailing Address - Phone:303-887-6631
Mailing Address - Fax:
Practice Address - Street 1:995 BLUE GENTIAN RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1542
Practice Address - Country:US
Practice Address - Phone:612-439-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty