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General NPI Number Information
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NPI Number | 1538131131
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Entity Type | Organization
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Legal Business Name | MINNEAPOLIS OPHTHALMOLOGY ASC LLC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 8401 GOLDEN VALLEY RD SUITE 340
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4486
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Country | US
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Telephone | 763-383-4150
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Fax | 763-383-4151
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Provider Business Mailing Address
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Address Line | 8401 GOLDEN VALLEY RD SUITE 340
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4486
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Country | US
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Telephone | 763-383-4150
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Fax | 763-383-4151
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILLIP A CLENDENIN
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Credential |
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Telephone | 615-665-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 320515
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License Number State | MN
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