Healthcare Provider Details

I. General information

NPI: 1134637457
Provider Name (Legal Business Name): DOWNTOWN EYES CROSSTOWN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 LYNDALE AVE S
RICHFIELD MN
55423-2477
US

IV. Provider business mailing address

800 NICOLLET MALL STE 260
MINNEAPOLIS MN
55402-7023
US

V. Phone/Fax

Practice location:
  • Phone: 612-869-1333
  • Fax: 612-869-2333
Mailing address:
  • Phone: 612-333-3937
  • Fax: 612-359-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3211
License Number StateMN

VIII. Authorized Official

Name: DR. MARY ANN JOY ZASTROW
Title or Position: OWNER
Credential: OD
Phone: 507-210-0469