Minnesota Eye Consultants, PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

MINNESOTA EYE CONSULTANTS, PA

Practice address

710 E 24TH St
Suite 100
Minneapolis, MN 55404-3840

Phone

(952) 888-5800

Fax

(612) 813-3601

NPI assigned

Feb 8, 2006

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 4

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1477526747",
    "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",
            "fax_number": "952-567-6156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 E 24TH ST",
            "address_2": "SUITE 100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043840",
            "telephone_number": "952-888-5800",
            "fax_number": "612-813-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EYE CONSULTANTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "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": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "24D1023514",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "680090400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP NUMBER",
            "identifier": "CG8516",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Minneapolis, MN
• Providers in Minneapolis, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.