Healthcare Provider Details

I. General information

NPI: 1992688071
Provider Name (Legal Business Name): MINNESOTA VISION THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9531 W 78TH ST STE 200
EDEN PRAIRIE MN
55344-3889
US

IV. Provider business mailing address

9531 W 78TH ST STE 200
EDEN PRAIRIE MN
55344-3889
US

V. Phone/Fax

Practice location:
  • Phone: 952-844-0844
  • Fax:
Mailing address:
  • Phone: 952-844-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: INNA TIMSHINA
Title or Position: OWNER
Credential:
Phone: 952-844-0844