NPIMap

Organization Active NPI

Minnesota Eye Consultants, PA

  • Ophthalmology Physician
  • Minnetonka, MN
National Provider Identifier
1932173374
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
10709 Wayzata Blvd
Suite 200
Minnetonka, MN 55305-5509
Phone
(952) 888-5800
Fax
(763) 553-1137
NPI assigned
Feb 14, 2006
Last updated
Feb 22, 2017By the provider in NPPES
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) 567-6143

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X NU
Ophthalmology Physician 207W00000X NU Primary
Clinical Medical Laboratory 291U00000X MN
Eyewear Supplier 332H00000X NU

Addresses

Primary practice location

10709 Wayzata Blvd
Suite 200
Minnetonka, MN 55305-5509

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
680090400MedicaidMN
CG8516OtherMNRR MEDICARE GROUP NUMBER
24D2023185OtherMNCLIA

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
24D2023185Minnesota Eye Consultants PA10709 Wayzata Blvd, Minnetonka, MN 55305Certificate of waiverApr 17, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1932173374",
    "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": "10709 WAYZATA BLVD",
            "address_2": "SUITE 200",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055509",
            "telephone_number": "952-888-5800",
            "fax_number": "763-553-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EYE CONSULTANTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "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": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "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": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "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"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "24D2023185",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.