Basic Information
| Provider Information | |||||||||
| NPI: | 1710078738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDINA EYE PHYSICIANS AND SURGEONS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7450 FRANCE AVE S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528328100 | ||||||||
| FaxNumber: | 9528328148 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 CHALUPSKY AVE SE | ||||||||
| Address2: | |||||||||
| City: | NEW PRAGUE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560712448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527587892 | ||||||||
| FaxNumber: | 9527587894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | MAYNE | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9528328143 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7314104 | MN | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 207W00000X | 7314104 | MN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.