Provider Demographics
NPI:1881032373
Name:FUSION HD
Entity Type:Organization
Organization Name:FUSION HD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:SEYLLER
Authorized Official - Last Name:PASSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-249-6537
Mailing Address - Street 1:3001 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1215
Mailing Address - Country:US
Mailing Address - Phone:651-770-3923
Mailing Address - Fax:651-770-5316
Practice Address - Street 1:3001 WHITE BEAR AVE N
Practice Address - Street 2:SUITE 1050
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1215
Practice Address - Country:US
Practice Address - Phone:651-770-3923
Practice Address - Fax:651-770-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty