Basic Information
Provider Information
NPI: 1376604280
EntityType: 2
ReplacementNPI:  
OrganizationName: GROUP HEALTH PLAN INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: HEALTHPARTNERS WOODBURY EYE CLINIC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8170 33RD AVE SOUTH
Address2: MAIL STOP 21110Q
City: BLOOMINGTON
State: MN
PostalCode: 554251672
CountryCode: US
TelephoneNumber: 9528837469
FaxNumber: 9528835395
Practice Location
Address1: 8325 SEASONS PKWY
Address2: SUITE 103
City: WOODBURY
State: MN
PostalCode: 55125
CountryCode: US
TelephoneNumber: 9528837469
FaxNumber: 9528835395
Other Information
ProviderEnumerationDate: 12/13/2006
LastUpdateDate: 07/23/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BJORKMAN
AuthorizedOfficialFirstName: LISA
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 9528837469
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332B00000X8600490MNY SuppliersDurable Medical Equipment & Medical Supplies 

No ID Information.


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