Provider Demographics
NPI:1407955420
Name:TOTAL EYE CARE PA
Entity Type:Organization
Organization Name:TOTAL EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-381-7611
Mailing Address - Street 1:116 KRESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-223-1270
Mailing Address - Fax:
Practice Address - Street 1:3035 DENMARK AVE
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2257
Practice Address - Country:US
Practice Address - Phone:651-405-0963
Practice Address - Fax:763-746-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2956261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2202941OtherMEDICA
MN2202818OtherMEDICA
MN979851041639OtherPERFERRED ONE
MN2203374OtherMEDICA
MN478947400OtherMINNESOTA HEALTH CARE
MN328M9ANOtherBLUE CROSS BLUE SHIELD
MN478947400OtherMINNESOTA HEALTH CARE
MN=========OtherSELECT CARE
MN=========OtherAETNA
MN328M9ANOtherBLUE CROSS BLUE SHIELD
MN=========OtherAETNA