Healthcare Provider Details

I. General information

NPI: 1841316627
Provider Name (Legal Business Name): MINNESOTA EYE INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 S BROADWAY
ALEXANDRIA MN
56308-3477
US

IV. Provider business mailing address

3401 S BROADWAY
ALEXANDRIA MN
56308-3477
US

V. Phone/Fax

Practice location:
  • Phone: 320-759-2020
  • Fax: 320-759-2424
Mailing address:
  • Phone: 320-759-2020
  • Fax: 320-759-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number31849
License Number StateMN

VIII. Authorized Official

Name: KENT A CARLSON
Title or Position: OWNER
Credential: MD
Phone: 320-759-2020