Provider Demographics
NPI:1962829580
Name:MINNESOTA OPTICAL LLC
Entity Type:Organization
Organization Name:MINNESOTA OPTICAL LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TONSAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-241-2083
Mailing Address - Street 1:19576 HOLT ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1287
Mailing Address - Country:US
Mailing Address - Phone:763-241-2083
Mailing Address - Fax:763-241-3801
Practice Address - Street 1:3333 HAZELTON RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4204
Practice Address - Country:US
Practice Address - Phone:952-926-6149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier