Minnesota Eye Consultants, PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

31920 Issued in MN

Legal business name

MINNESOTA EYE CONSULTANTS, PA

Practice address

11091 Ulysses St NE
Suite 300
Blaine, MN 55434-4237

Phone

(952) 888-5800

Fax

(763) 421-8297

NPI assigned

Jun 10, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brent L Wilde

Title

President

Phone

(952) 567-6143

Specialties & licenses 2

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

MN Eye Consultants PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Minnesota Eye Consultants, PA

  • Optometrist
  • Bloomington, MN
  • NPI 1205930542
  NPD tax ID
• Minnesota Eye Consultants, PA

  • Ophthalmology Physician
  • Falcon Heights, MN
  • NPI 1467815357
  NPD tax ID
• Minnesota Eye Consultants, PA

  • Eyewear Supplier
  • Bloomington, MN
  • NPI 1952452674
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1104146265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "SUITE 425",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313100",
            "telephone_number": "952-888-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11091 ULYSSES ST NE",
            "address_2": "SUITE 300",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344237",
            "telephone_number": "952-888-5800",
            "fax_number": "763-421-8297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EYE CONSULTANTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-10",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-567-6143"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "31920",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "24D2023184",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Midwest Medical Holdings, LLC
• Midwest Respiratory Care Inc.
• Andrea Catherine Mierau, PT, DPT
• Agassi Mila
• Mina Skilled Nursing LLC
• Minnesota Eye Laser & Surgery Centers, LLC
• Minnesota Health Homecare LLC
• Minnesota Interventional Pain Associates
• Minnesota Loon Home Care LLC
• Minnesota Loon Transport LLC

• Ophthalmology Physician in Blaine, MN
• Providers in Blaine, MN by specialty
• Ophthalmology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.