Provider Demographics
NPI:1255575973
Name:BURNSVILLE EYE CLINIC LLC
Entity type:Organization
Organization Name:BURNSVILLE EYE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-894-1400
Mailing Address - Street 1:150 TRAVELERS TRAIL EAST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-894-1400
Mailing Address - Fax:952-808-2216
Practice Address - Street 1:150 TRAVELERS TRAIL EAST
Practice Address - Street 2:SUITE D
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-894-1400
Practice Address - Fax:952-808-2216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH SUBURBAN EYE CARE SPECIALISTS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1518037563OtherNPI
MN2203175OtherUNITED HEALTH CARE
MN2823OtherMN LICENSE
MNHP36326OtherHEALTHPARTNERS
MN499R7LAOtherBLUE CROSS BLUE SHIELD MN
MN202779692OtherVSP
MN2203175OtherMEDICA
MNA61971031584OtherPREFERRED ONE
MNA61971031584OtherPREFERRED ONE
MN1518037563OtherNPI
MN2203175OtherMEDICA