Provider Demographics
NPI:1831357433
Name:EDINA MN OPHTHALMOLOGY ASC LLC
Entity type:Organization
Organization Name:EDINA MN OPHTHALMOLOGY ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:3124 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4227
Mailing Address - Country:US
Mailing Address - Phone:952-848-8338
Mailing Address - Fax:952-848-8302
Practice Address - Street 1:3124 W 70TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4227
Practice Address - Country:US
Practice Address - Phone:952-848-8338
Practice Address - Fax:952-848-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN430006881OtherBUHAIN, CRNA
MN430006881OtherBUHAIN, CRNA