Healthcare Provider Details

I. General information

NPI: 1457186850
Provider Name (Legal Business Name): BLUE LAKES EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 VIKINGS PKWY STE B
EAGAN MN
55121-1139
US

IV. Provider business mailing address

855 VIKINGS PKWY STE B
EAGAN MN
55121-1187
US

V. Phone/Fax

Practice location:
  • Phone: 651-280-4420
  • Fax: 651-280-4115
Mailing address:
  • Phone: 651-280-4420
  • Fax: 651-280-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: EMILY KAY BJORE
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 651-280-4420