NPIMap

Organization Active NPI

Minnesota Eye Consultants, PA

  • Ophthalmology Physician
  • Maplewood, MN
National Provider Identifier
1861465064
Registry record updated Feb 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MINNESOTA EYE CONSULTANTS, PA
Practice address
1965 11TH Ave E
Suite 102
Maplewood, MN 55109-5167
Phone
(952) 888-5800
Fax
(651) 748-4445
NPI assigned
Feb 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2017

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) 888-5800

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Clinical Medical Laboratory 291U00000X 24D2023181 MN
Eyewear Supplier 332H00000X

Addresses

Primary practice location

1965 11TH Ave E
Suite 102
Maplewood, MN 55109-5167

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
24D2023181OtherMNCLIA
680090400MedicaidMN
CG8516OtherMNRR MEDICARE GROUP NUMBER

National Provider Directory

National Provider Directory

NPI Registry JSON

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": "1861465064",
    "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": "1965 11TH AVE E",
            "address_2": "SUITE 102",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095167",
            "telephone_number": "952-888-5800",
            "fax_number": "651-748-4445"
        }
    ],
    "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": "952-888-5800"
    },
    "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": "24D2023181",
            "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": "24D2023181",
            "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": []
}

Other providers in Maplewood, MN

Sources for this page

  • 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.