Healthcare Provider Details

I. General information

NPI: 1851911986
Provider Name (Legal Business Name): WILLIAM MIYOSHI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date: 03/27/2026
Reactivation Date: 05/01/2026

III. Provider practice location address

995 BLUE GENTIAN RD
EAGAN MN
55121-1542
US

IV. Provider business mailing address

995 BLUE GENTIAN RD
EAGAN MN
55121-1542
US

V. Phone/Fax

Practice location:
  • Phone: 612-439-8075
  • Fax:
Mailing address:
  • Phone: 612-439-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3709
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: