Provider Demographics
NPI:1467815357
Name:MINNESOTA EYE CONSULTANTS, PA
Entity Type:Organization
Organization Name:MINNESOTA EYE CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-888-5800
Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:SUITE 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:952-567-6156
Practice Address - Street 1:1347 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:FALCON HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55113-6302
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:651-641-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty