Healthcare Provider Details

I. General information

NPI: 1003802950
Provider Name (Legal Business Name): MINNESOTA EYE INSTITUTE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/24/2012
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

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