Minnesota Eye Consultants, PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

MINNESOTA EYE CONSULTANTS, PA

Practice address

9801 Dupont Ave S
Suite 200
Bloomington, MN 55431-3100

Phone

(952) 888-5800

Fax

(952) 884-2656

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

Clifton Chad Bazhaw

Title

Chief Revenue Officer

Phone

(214) 893-0471

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 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

Locations

Interoperability endpoints

• Direct secure messaging: cserels@uvpmec.intellechartdirect.net
• Direct secure messaging: pschultz@uvpmec.intellechartdirect.net
• Direct secure messaging: ksimko@uvpmec.intellechartdirect.net
• Direct secure messaging: nbergman@uvpmec.intellechartdirect.net
• Direct secure messaging: egullingsrud@uvpmec.intellechartdirect.net
• Direct secure messaging: kbrettin@uvpmec.intellechartdirect.net
• Direct secure messaging: ksandeen@uvpmec.intellechartdirect.net
• Direct secure messaging: ckopp@uvpmec.intellechartdirect.net
• Direct secure messaging: bjohnson@uvpmec.intellechartdirect.net
• Direct secure messaging: ldisterhaft@uvpmec.intellechartdirect.net
• Direct secure messaging: jjenness@uvpmec.intellechartdirect.net
• Direct secure messaging: mhuang@uvpmec.intellechartdirect.net
• Direct secure messaging: tmeirick@uvpmec.intellechartdirect.net
• Direct secure messaging: jking@uvpmec.intellechartdirect.net
• Direct secure messaging: ksnyder@uvpmec.intellechartdirect.net

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Omar Essam Awad, MD

  • Ophthalmology Physician
  • Woodbury, MN
  • NPI 1619942174
  Medicare reassignment Care Compare group NPD
• Tara Rae Barth, O.D.

  • Corneal and Contact Management Optometrist
  • Bloomington, MN
  • NPI 1548499676
  Medicare reassignment Care Compare group NPD
• Karina Marie Bement, OD

  • Optometrist
  • Bloomington, MN
  • NPI 1952091654
  Medicare reassignment Care Compare group NPD
• Nicole Marie Bergman, OD

  • Optometrist
  • Bloomington, MN
  • NPI 1275272593
  Medicare reassignment Care Compare group NPD
• Alyson L Blakstad, OD

  • Corneal and Contact Management Optometrist
  • Minnetonka, MN
  • NPI 1427043660
  Medicare reassignment Care Compare group NPD
• Cristelle Elise Boots, OD

  • Optometrist
  • Blaine, MN
  • NPI 1699323162
  Medicare reassignment Care Compare group NPD
• Mark Buboltz, O.D.

  • Corneal and Contact Management Optometrist
  • Bloomington, MN
  • NPI 1205249620
  Medicare reassignment Care Compare group NPD
• Clara M Choo, M.D.

  • Ophthalmology Physician
  • Bloomington, MN
  • NPI 1760746028
  Medicare reassignment Care Compare group NPD
• Noumia Cloutier-Gill, OD

  • Corneal and Contact Management Optometrist
  • Bloomington, MN
  • NPI 1457508988
  Medicare reassignment Care Compare group NPD
• Lauren Elizabeth Disterhaft, OD

  • Optometrist
  • Bloomington, MN
  • NPI 1831086057
  Medicare reassignment Care Compare group NPD
• Gina Marie Doeden, OD

  • Corneal and Contact Management Optometrist
  • Bloomington, MN
  • NPI 1558350207
  Medicare reassignment Care Compare group NPD
• Mark Dsouza, PA

  • Physician Assistant
  • Minnetonka, MN
  • NPI 1902153125
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1508839879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S STE 425",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313873",
            "telephone_number": "952-888-5800",
            "fax_number": "952-884-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "SUITE 200",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313100",
            "telephone_number": "952-888-5800",
            "fax_number": "952-884-2656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12501 Whitewater Dr Ste 310",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553439436",
            "country_code": "US",
            "telephone_number": "952-888-5800",
            "fax_number": "952-567-6156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINNESOTA EYE CONSULTANTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A",
        "authorized_official_last_name": "BAZHAW",
        "authorized_official_first_name": "CLIFTON",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "CHIEF REVENUE OFFICER",
        "authorized_official_telephone_number": "214-893-0471"
    },
    "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": "207WX0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MN",
            "license": "24D2023179",
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Minnesota Eye Laser & Surgery Centers, LLC
• Minnesota Haven Homes
• Minnesota Haven Homes, LLC
• Minnesota Masonic Home Care Center

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

• 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.