=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427149442
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDINA EYE PHYSICIANS AND SURGEONS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 919 NORTHLAND DR
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55371-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-241-5878
-----------------------------------------------------
Fax | 763-241-5877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7450 FRANCE AVE S SUITE 100
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-4787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-832-8100
-----------------------------------------------------
Fax | 952-832-8148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCIAL MANAGER
-----------------------------------------------------
Name | MS. D C NEEDHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-832-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 7314104
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7314104
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------