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General NPI Number Information
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NPI Number | 1114921996
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Entity Type | Organization
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Legal Business Name | OPHTHALMOLOGY PA
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 3100 W 70TH ST
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City | EDINA
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State | MN
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Zip | 55435-4227
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Country | US
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Telephone | 952-848-8300
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Fax | 952-848-8313
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Provider Business Mailing Address
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Address Line | 3100 W 70TH ST
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City | EDINA
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State | MN
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Zip | 55435-4227
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Country | US
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Telephone | 952-848-8300
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Fax | 952-848-8313
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Authorized Official
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Title or Position | BUSINESS OFFICE
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Name | JESSICA LOUISE BERG
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Credential |
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Telephone | 952-848-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 0026007
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0026007
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License Number State | MN
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