Regional Eye Specialists LLC
Organization Active NPI Eyewear Supplier · Chaska, MN
NPI 1619703006 · NPPES record last updated Mar 4, 2025
Key facts
- NPI
- 1619703006
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- Legal business name
- REGIONAL EYE SPECIALISTS LLC
- Practice address
- 1200 Chaska Creek Way Ste 110
Chaska, MN 55318-2749 - Phone
- (952) 466-3937
- Fax
- (952) 466-3936
- NPI assigned
- Sep 11, 2024
- Organization subpart
- No
Authorized official
- Name
- Clifton Chad Bazhaw
- Title
- Chief Revenue Officer
- Phone
- (469) 270-6658
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Member organizations 1
Practitioners 17
-
Tara Rae Barth, O.D.
-
Chad R. Dockter, OD
-
Amy Jean Freed, O.D.
-
Christopher J Freed, O.D.
-
Scott A Glaser, O.D.
-
Aubree Thorseth, OD
-
Mark W Wellnitz, O.D.
-
Allan D Wortz, OD
-
Michael P Merck, MD
-
Anna Claire Aho, OD
-
Paul G Eklof, OD
-
Blake Kvidt, OD
-
Katie Nicole Tancabel, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Southwest Eye Care |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250226001584 | MN | DME Supplier - Physician - Ophthalmology |
9032010251 | Practice locations: Chaska, MN |
National Provider Directory
- Tax ID family
- Regional Eye Specialists LL
Locations
741 Enterprise Dr E
Belle Plaine, MN 56011
Phone (952) 495-6070
1200 Chaska Creek Way
Ste 110
Chaska, MN 55318
Phone (320) 587-6308
13550 Wayzata Blvd
Minnetonka, MN 55305
Phone (952) 479-6320
12983 Ridgedale Dr
Minnetonka, MN 55305
Phone (320) 864-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | |||
| Eyewear Supplier | 332H00000X | Yes |
Addresses
Primary practice location
1200 Chaska Creek Way Ste 110
Chaska, MN 55318-2749
Mailing address
1200 Chaska Creek Way Ste 110
Chaska, MN 55318-2749
Phone (952) 466-3937
Other providers in Chaska, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.