Healthcare Provider Details

I. General information

NPI: 1720059421
Provider Name (Legal Business Name): MINNESOTA EYE LASER & SURGERY CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 DUPONT AVE S SUITE 100
BLOOMINGTON MN
55431-3100
US

IV. Provider business mailing address

9801 DUPONT AVE S SUITE 425
BLOOMINGTON MN
55431-3100
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-5800
  • Fax: 952-567-6156
Mailing address:
  • Phone: 952-888-5800
  • Fax: 952-567-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number327379
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLIFTON BAZHAW
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 214-893-0471