Healthcare Provider Details

I. General information

NPI: 1396725602
Provider Name (Legal Business Name): COMPREHENSIVE OPHTHALMOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 WEST 76TH ST #303
EDINA MN
55435
US

IV. Provider business mailing address

275 HOLLANDER RD
WAYZATA MN
55391
US

V. Phone/Fax

Practice location:
  • Phone: 952-844-2020
  • Fax: 952-844-2021
Mailing address:
  • Phone: 952-476-8602
  • Fax: 952-476-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL F BRUER
Title or Position: OWNER
Credential: MD
Phone: 952-476-8602