Healthcare Provider Details

I. General information

NPI: 1669152435
Provider Name (Legal Business Name): EYES UNLIMITED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 LAKE SHORE AVE
MAPLE PLAIN MN
55359-8608
US

IV. Provider business mailing address

3112 LAKE SHORE AVE
MAPLE PLAIN MN
55359-8608
US

V. Phone/Fax

Practice location:
  • Phone: 763-843-4264
  • Fax:
Mailing address:
  • Phone: 763-843-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MUHANNAH S KAKISH
Title or Position: PRESIDENT
Credential:
Phone: 763-843-4262