Healthcare Provider Details

I. General information

NPI: 1649379132
Provider Name (Legal Business Name): CONRAD EYE SERVICES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VILLAGE CENTER DR SUITE 300
NORTH OAKS MN
55127-7090
US

IV. Provider business mailing address

200 VILLAGE CENTER DR SUITE 300
NORTH OAKS MN
55127-7090
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-0902
  • Fax:
Mailing address:
  • Phone: 651-482-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL S CONRAD
Title or Position: OWNDER
Credential: MD
Phone: 651-482-0902