Provider Demographics
NPI:1316379647
Name:MINNESOTA EYE LASER & SURGERY CENTERS, LLC
Entity Type:Organization
Organization Name:MINNESOTA EYE LASER & SURGERY CENTERS, LLC
Other - Org Name:MINNESOTA EYE LASER & SURGERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-270-6658
Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:SUTIE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-888-5800
Mailing Address - Fax:
Practice Address - Street 1:10709 WAYZATA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5509
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-567-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical