MEDICARE: VISUAL EDGE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	1068294	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	0626900005	OTHER	MN	MEDICARE DMERC REGION B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102075	OTHER	MN	COLE MANAGED VISION
2	21-20194	OTHER	MN	MEDICA/UNITED HEALTHCARE
4	65160PE	OTHER	MN	BCBS VISION EXAMS
5	PE1512548	OTHER	MN	CLARITY VISION
6	65161PE	OTHER	MN	BCBS EYEWEAR

General Provider Information

NPI Number	:	1457357071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISUAL EDGE, INC

Provider Business Mailing Address
First Line	:	3333 HAZELTON RD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4204
Country	:	US
Telephone Number	:	952-926-5300
Fax Number	:	952-915-9212

Provider Business Practice Location Address
First Line	:	3333 HAZELTON RD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4204
Country	:	US
Telephone Number	:	952-926-6149
Fax Number	:	952-926-2729

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOSEPH ZWEBER
Credential	:
Telephone Number	:	952-345-5044

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/22/2020

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Directions to “VISUAL EDGE, INC ” Practice Location

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