Provider Demographics
NPI:1720739022
Name:ESSENTIAL EYECARE MINNESOTA INC
Entity Type:Organization
Organization Name:ESSENTIAL EYECARE MINNESOTA INC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LADEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-239-2360
Mailing Address - Street 1:144 TYLER RD N STE B
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1889
Mailing Address - Country:US
Mailing Address - Phone:651-388-3838
Mailing Address - Fax:
Practice Address - Street 1:144 TYLER RD N STE B
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1889
Practice Address - Country:US
Practice Address - Phone:651-388-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty