Healthcare Provider Details

I. General information

NPI: 1588708630
Provider Name (Legal Business Name): IMI'S MN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 ROBERT ST S
WEST SAINT PAUL MN
55118-3923
US

IV. Provider business mailing address

12577 WAYZATA BLVD
MINNETONKA MN
55305-1938
US

V. Phone/Fax

Practice location:
  • Phone: 651-451-1805
  • Fax: 651-451-0330
Mailing address:
  • Phone: 952-546-4414
  • Fax: 952-541-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE ARENDS
Title or Position: OWNER
Credential:
Phone: 952-546-4414