Healthcare Provider Details

I. General information

NPI: 1497837306
Provider Name (Legal Business Name): NORTHWEST EYE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 GOLDEN VALLEY RD STE 100
GOLDEN VALLEY MN
55427-4472
US

IV. Provider business mailing address

8401 GOLDEN VALLEY RD STE 330
GOLDEN VALLEY MN
55427-4488
US

V. Phone/Fax

Practice location:
  • Phone: 763-416-7600
  • Fax: 763-416-7634
Mailing address:
  • Phone: 763-416-7629
  • Fax: 763-383-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number360
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFTON CHAD BAZHAW
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 214-893-0471