Healthcare Provider Details

I. General information

NPI: 1427149442
Provider Name (Legal Business Name): EDINA EYE PHYSICIANS AND SURGEONS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 NORTHLAND DR
PRINCETON MN
55371-2172
US

IV. Provider business mailing address

7450 FRANCE AVE S SUITE 100
EDINA MN
55435-4787
US

V. Phone/Fax

Practice location:
  • Phone: 763-241-5878
  • Fax: 763-241-5877
Mailing address:
  • Phone: 952-832-8100
  • Fax: 952-832-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7314104
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7314104
License Number StateMN

VIII. Authorized Official

Name: MS. D C NEEDHAM
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 952-832-8100