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General NPI Number Information
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NPI Number | 1720982010
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Entity Type | Organization
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Legal Business Name | NORTHWEST EYE CLINIC, LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 2601 39TH AVE NE STE 1
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City | ST. ANTHONY
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State | MN
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Zip | 55421-4372
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Country | US
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Telephone | 763-416-7600
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Fax | 763-416-7634
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Provider Business Mailing Address
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Address Line | 8401 GOLDEN VALLEY RD STE 330
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4687
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Country | US
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Telephone | 763-416-7600
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Fax | 763-416-7634
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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 | 214-893-0471
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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 |
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License Number State | NULL
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