Provider Demographics
NPI:1407977762
Name:CHU LASER EYE INSTITUTE, PA
Entity Type:Organization
Organization Name:CHU LASER EYE INSTITUTE, PA
Other - Org Name:CHU VISION INSTITUTE, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YUNSEN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-835-0965
Mailing Address - Street 1:9117 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3522
Mailing Address - Country:US
Mailing Address - Phone:952-835-0965
Mailing Address - Fax:952-835-1092
Practice Address - Street 1:9117 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3522
Practice Address - Country:US
Practice Address - Phone:952-835-0965
Practice Address - Fax:952-835-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180000911Medicare ID - Type Unspecified