Provider Demographics
NPI:1477785442
Name:EYES OF MINNESOTA, LLC
Entity Type:Organization
Organization Name:EYES OF MINNESOTA, LLC
Other - Org Name:EYES OF MENDOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-686-9393
Mailing Address - Street 1:740 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3763
Mailing Address - Country:US
Mailing Address - Phone:651-686-9393
Mailing Address - Fax:651-556-2568
Practice Address - Street 1:740 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-3763
Practice Address - Country:US
Practice Address - Phone:651-686-9393
Practice Address - Fax:651-556-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty