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General NPI Number Information
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NPI Number | 1992688071
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Entity Type | Organization
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Legal Business Name | MINNESOTA VISION THERAPY CENTER LLC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 9531 W 78TH ST STE 200
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3889
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Country | US
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Telephone | 952-844-0844
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Fax |
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Provider Business Mailing Address
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Address Line | 9531 W 78TH ST STE 200
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3889
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Country | US
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Telephone | 952-844-0844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | INNA TIMSHINA
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Credential |
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Telephone | 952-844-0844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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