Healthcare Provider Details

I. General information

NPI: 1205943214
Provider Name (Legal Business Name): EYE CARE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 STINSON BLVD SUITE 100
MINNEAPOLIS MN
55421-3488
US

IV. Provider business mailing address

825 NICOLLET MALL SUITE 2000
MINNEAPOLIS MN
55402-2606
US

V. Phone/Fax

Practice location:
  • Phone: 612-788-1621
  • Fax: 612-788-8079
Mailing address:
  • Phone: 612-338-4861
  • Fax: 612-333-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number74
License Number StateMN

VIII. Authorized Official

Name: ROBERT WARSHAWSKY
Title or Position: SR PARTNER
Credential: MD
Phone: 612-338-4861