Provider Demographics
NPI:1932167772
Name:ALEXANDRIA EYE CLINIC P.A.
Entity Type:Organization
Organization Name:ALEXANDRIA EYE CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:GESS
Authorized Official - Last Name:RISTVEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:320-762-2166
Mailing Address - Street 1:3101 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3162
Mailing Address - Country:US
Mailing Address - Phone:605-371-7100
Mailing Address - Fax:605-371-7199
Practice Address - Street 1:2600 JEFFERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3410
Practice Address - Country:US
Practice Address - Phone:320-762-2166
Practice Address - Fax:605-371-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20870261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN242392800Medicaid
MND48577Medicare UPIN
MN242392800Medicaid