Provider Demographics
NPI:1649379132
Name:CONRAD EYE SERVICES, PLC
Entity Type:Organization
Organization Name:CONRAD EYE SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-482-0902
Mailing Address - Street 1:200 VILLAGE CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7090
Mailing Address - Country:US
Mailing Address - Phone:651-482-0902
Mailing Address - Fax:
Practice Address - Street 1:200 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7090
Practice Address - Country:US
Practice Address - Phone:651-482-0902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03347Medicare ID - Type Unspecified