Healthcare Provider Details

I. General information

NPI: 1952452674
Provider Name (Legal Business Name): MINNESOTA EYE CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 DUPONT AVE S SUITE 200
BLOOMINGTON MN
55431-3100
US

IV. Provider business mailing address

710 E 24TH ST SUITE 106
MINNEAPOLIS MN
55404-3840
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-5800
  • Fax:
Mailing address:
  • Phone: 612-813-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1751
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number1751
License Number StateMN

VIII. Authorized Official

Name: CANDACE S SIMERSON
Title or Position: PRESIDENT
Credential:
Phone: 612-813-3600