Provider Demographics
NPI:1275175119
Name:SUMMIT EYE CARE OF MINNESOTA SC
Entity Type:Organization
Organization Name:SUMMIT EYE CARE OF MINNESOTA SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VUKICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-220-7767
Mailing Address - Street 1:5715 W OLD SHAKOPEE RD # 150
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3366 OAKDALE AVE N STE 140
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2961
Practice Address - Country:US
Practice Address - Phone:612-445-9110
Practice Address - Fax:952-479-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty