Healthcare Provider Details

I. General information

NPI: 1689604316
Provider Name (Legal Business Name): RETINA CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E 24TH ST SUITE 304
MINNEAPOLIS MN
55404-3846
US

IV. Provider business mailing address

710 E 24TH ST SUITE 304
MINNEAPOLIS MN
55404-3846
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-2292
  • Fax: 952-460-5274
Mailing address:
  • Phone: 612-871-2292
  • Fax: 952-460-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDHISH RAMAN BHAVSAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 612-871-2292