Healthcare Provider Details

I. General information

NPI: 1326019829
Provider Name (Legal Business Name): MINNESOTA EYE CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 DUPONT AVE SOUTH SUITE 200
BLOOMINGTON MN
55431-3180
US

IV. Provider business mailing address

9801 DUPONT AVE S STE 425
BLOOMINGTON MN
55431-3873
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 Code332H00000X
TaxonomyEyewear Supplier
License Number1751
License Number StateMN

VIII. Authorized Official

Name: CLIFTON CHAD BAZHAW
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 469-270-6658