Provider Demographics
NPI:1689870156
Name:NORTH SUBURBAN EYE SPECIALISTS, LLP
Entity Type:Organization
Organization Name:NORTH SUBURBAN EYE SPECIALISTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DELTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-421-7420
Mailing Address - Street 1:11855 ULYSSES ST.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434
Mailing Address - Country:US
Mailing Address - Phone:763-421-7420
Mailing Address - Fax:763-421-0730
Practice Address - Street 1:3790 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2629
Practice Address - Country:US
Practice Address - Phone:763-421-7420
Practice Address - Fax:763-421-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty