MEDICARE: LEXINGTON EYE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	E15851	MN
2	207W00000X	Ophthalmology Physician	29010	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437213527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	1570 CONCORDIA AVE
Second Line	:	SUITE 202
City	:	ST PAUL
State	:	MN
Zip	:	55104-5345
Country	:	US
Telephone Number	:	651-646-7419
Fax Number	:	651-637-2778

Provider Business Practice Location Address
First Line	:	1570 CONCORDIA AVE
Second Line	:	SUITE 202
City	:	ST PAUL
State	:	MN
Zip	:	55104-5345
Country	:	US
Telephone Number	:	651-646-7419
Fax Number	:	651-637-2778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK WEDUL
Credential	:	MD
Telephone Number	:	651-646-7419

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	10/24/2016

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Directions to “LEXINGTON EYE ASSOCIATES ” Practice Location

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