Healthcare Provider Details

I. General information

NPI: 1265351357
Provider Name (Legal Business Name): EYE CARE LOUNGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14043 HWY 13 S
SAVAGE MN
55378-3100
US

IV. Provider business mailing address

14043 HWY 13 S
SAVAGE MN
55378-3100
US

V. Phone/Fax

Practice location:
  • Phone: 952-697-2525
  • Fax: 952-697-2545
Mailing address:
  • Phone: 952-697-2525
  • Fax: 952-697-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARLON WILSON
Title or Position: OWNER
Credential:
Phone: 952-697-2525