NPIMap

Organization Active NPI

Minnesota Eye Laser & Surgery Centers, LLC

Doing business as Minnesota Eye Laser & Surgery Centers

  • Ambulatory Surgical Clinic/Center
  • Minnetonka, MN
National Provider Identifier
1316379647
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
10709 Wayzata Blvd
Suite 100
Minnetonka, MN 55305-5509
Phone
(952) 888-5800
Fax
(952) 567-6156
NPI assigned
Aug 9, 2013
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 Primary

Addresses

Primary practice location

10709 Wayzata Blvd
Suite 100
Minnetonka, MN 55305-5509

Mailing address

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

Other names 1

  • Minnesota Eye Laser & Surgery Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060106000289 MN Part B Supplier - Ambulatory Surgical Center 8123041068 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bloomington, MN
O20140709002619 MN Part B Supplier - Ambulatory Surgical Center 8123041068 Practice locations: Minnetonka, MN

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Minnesota Eye Laser and Surgery Centers LLC MinnetonkaCCN 24C0001080
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2064339Minnesota Eye Laser & Surgery Centers10709 Wayzata Blvd Suite 100, Minnetonka, MN 55305Certificate of waiverAug 18, 2027

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.

NPI Registry JSON

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

{
    "created_epoch": "1376006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1316379647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "SUTIE 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": "10709 WAYZATA BLVD",
            "address_2": "SUITE 100",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055509",
            "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": "2013-08-09",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Minnetonka, 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.