Healthcare Provider Details

I. General information

NPI: 1679623862
Provider Name (Legal Business Name): SOUTHWEST EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHASKA CREEK WAY SUITE 110
CHASKA MN
55318-2525
US

IV. Provider business mailing address

1200 CHASKA CREEK WAY SUITE 110
CHASKA MN
55318-2525
US

V. Phone/Fax

Practice location:
  • Phone: 952-466-3937
  • Fax: 952-466-3936
Mailing address:
  • Phone: 952-466-3937
  • Fax: 952-466-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number51388
License Number StateMN

VIII. Authorized Official

Name: DR. CHRISTOPHER FREED
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 952-466-3937