Provider Demographics
NPI:1942721949
Name:KOPP & OLSON EYE CARE, INC
Entity Type:Organization
Organization Name:KOPP & OLSON EYE CARE, INC
Other - Org Name:EYEWORKS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-451-1100
Mailing Address - Street 1:6575 CAHILL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-2065
Mailing Address - Country:US
Mailing Address - Phone:651-451-1100
Mailing Address - Fax:651-451-3939
Practice Address - Street 1:6575 CAHILL AVE STE 101
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-2065
Practice Address - Country:US
Practice Address - Phone:651-451-1100
Practice Address - Fax:651-451-3939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOPP & OLSON EYE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410003800Medicaid