NPIMap

Organization Active NPI

Minnesota Eye Laser & Surgery Centers, LLC

Doing business as Minnesota Eye Laser & Surgery Centers

  • Ambulatory Surgical Clinic/Center
  • Blaine, MN
National Provider Identifier
1205152618
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MINNESOTA EYE LASER & SURGERY CENTERS, LLC
Doing business as
Minnesota Eye Laser & Surgery Centers
Practice address
11091 Ulysses Street NE
Suite 400
Blaine, MN 55434-4237
Phone
(952) 888-5800
Fax
(952) 567-6156
NPI assigned
Apr 9, 2010
Last updated
Mar 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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

Authorized official

Name
Clifton Bazhaw
Title
Sr VP Revenue Cycle
Phone
(214) 893-0471

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

11091 Ulysses Street NE
Suite 400
Blaine, MN 55434-4237

Mailing address

9801 Dupont Ave S
Suite 425
Bloomington, MN 55431-3100
Phone (952) 888-5800

Other identifiers 1

IdentifierTypeStateIssuer
24D2007008OtherMNCLIA

Other names 1

  • Minnesota Eye Laser & Surgery Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100517000891 MN Part B Supplier - Ambulatory Surgical Center 8123041068 Practice locations: Blaine, MN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Minnesota Eye Laser and Surgery Centers LLC BlaineCCN 24C0001071
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
MN Eye Laser Surgery Ctr6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

11091 Ulysses St NE
Ste 400
Blaine, MN 55434
Phone (763) 421-9410

NPI Registry JSON

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

{
    "created_epoch": "1270771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1205152618",
    "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 STREET NE",
            "address_2": "SUITE 400",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344237",
            "telephone_number": "952-888-5800",
            "fax_number": "952-567-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EYE LASER & SURGERY CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-09",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A",
        "authorized_official_last_name": "BAZHAW",
        "authorized_official_first_name": "CLIFTON",
        "authorized_official_title_or_position": "SR VP REVENUE CYCLE",
        "authorized_official_telephone_number": "214-893-0471"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "24D2007008",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Eye Laser & Surgery Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minnesota Eye Laser & Surgery Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.