Provider Demographics
NPI:1851717136
Name:ERIC RICHARD NELSON MD
Entity Type:Organization
Organization Name:ERIC RICHARD NELSON MD
Other - Org Name:MINNESOTA OPHTHALMIC PLASTIC SURGERY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-925-4161
Mailing Address - Street 1:6405 FRANCE AVE S
Mailing Address - Street 2:SUITE W460
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2163
Mailing Address - Country:US
Mailing Address - Phone:952-925-4161
Mailing Address - Fax:952-925-3520
Practice Address - Street 1:6405 FRANCE AVE S
Practice Address - Street 2:SUITE W460
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2163
Practice Address - Country:US
Practice Address - Phone:952-925-4161
Practice Address - Fax:952-925-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33370207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN323003100Medicaid
MNE48449Medicare UPIN
MN180000287Medicare PIN