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General NPI Number Information
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NPI Number | 1326019829
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Entity Type | Organization
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Legal Business Name | MINNESOTA EYE CONSULTANTS, PA
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 9801 DUPONT AVE SOUTH SUITE 200
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3180
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Country | US
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Telephone | 952-888-5800
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Fax | 952-567-6156
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Provider Business Mailing Address
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Address Line | 9801 DUPONT AVE S STE 425
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3873
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Country | US
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Telephone | 952-888-5800
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Fax | 952-567-6156
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Authorized Official
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Title or Position | CHIEF REVENUE OFFICER
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Name | CLIFTON CHAD BAZHAW
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Credential |
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Telephone | 469-270-6658
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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 | 1751
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License Number State | MN
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