Healthcare Provider Details

I. General information

NPI: 1538131131
Provider Name (Legal Business Name): MINNEAPOLIS OPHTHALMOLOGY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 GOLDEN VALLEY RD SUITE 340
GOLDEN VALLEY MN
55427-4486
US

IV. Provider business mailing address

8401 GOLDEN VALLEY RD SUITE 340
GOLDEN VALLEY MN
55427-4486
US

V. Phone/Fax

Practice location:
  • Phone: 763-383-4150
  • Fax: 763-383-4151
Mailing address:
  • Phone: 763-383-4150
  • Fax: 763-383-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number320515
License Number StateMN

VIII. Authorized Official

Name: PHILLIP A CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283