Provider Demographics
NPI:1952452674
Name:MINNESOTA EYE CONSULTANTS, PA
Entity Type:Organization
Organization Name:MINNESOTA EYE CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-813-3600
Mailing Address - Street 1:710 E 24TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3840
Mailing Address - Country:US
Mailing Address - Phone:612-813-3600
Mailing Address - Fax:
Practice Address - Street 1:9801 DUPONT AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1751152WC0802X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear Supplier