Provider Demographics
NPI:1447404645
Name:METROPOLITAN EYE CARE SPECIALISTS
Entity Type:Organization
Organization Name:METROPOLITAN EYE CARE SPECIALISTS
Other - Org Name:METROPOLITAN EYE CARE SPECIALISTS, P.A. II
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-894-1400
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-6170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 E TRAVELERS TRL STE D
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6890
Practice Address - Country:US
Practice Address - Phone:952-894-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN EYE CARE SPECIALISTS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36947207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty