Provider Demographics
NPI:1205943214
Name:EYE CARE ASSOCIATES PA
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WARSHAWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-338-4861
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-338-4861
Mailing Address - Fax:612-333-8306
Practice Address - Street 1:4001 STINSON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-3488
Practice Address - Country:US
Practice Address - Phone:612-788-1621
Practice Address - Fax:612-788-8079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7D637EYOtherBLUE SHIELD
MN2793OtherHEALTHPARTNERS
MN7D637EYOtherBLUE SHIELD
MNC01929Medicare ID - Type UnspecifiedMEDICARE GROUP NE
MN1021630001Medicare ID - Type UnspecifiedADMINISTAR NE