NPIMap

Organization Active NPI

Minnesota Eye Laser & Surgery Centers, LLC

  • Ambulatory Surgical Clinic/Center
  • Minnetonka, MN
National Provider Identifier
1932882230
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MINNESOTA EYE LASER & SURGERY CENTERS, LLC
Practice address
12501 Whitewater Dr Ste 320
Minnetonka, MN 55343-9436
Phone
(952) 888-5800
Fax
(952) 567-6156
NPI assigned
Aug 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

12501 Whitewater Dr Ste 320
Minnetonka, MN 55343-9436

Mailing address

9801 Dupont Ave S Ste 425
Bloomington, MN 55431-3873
Phone (952) 888-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240327002330 MN Part B Supplier - Ambulatory Surgical Center 8123041068 Practice locations: Minnetonka, MN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Minnesota Eye Laser and Surgery Centers LLCCCN 24C0001125
Medicare certification status
ActiveFrom the Provider of Services file

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
24D2296669Minnesota Eye Laser & Surgery Centers LLC12501 Whitewater Dr Ste 320, Minnetonka, MN 55343Certificate of waiverJan 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
MN Eye Laser Surgery Ctr6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12501 Whitewater Dr
Ste 320
Minnetonka, MN 55343
Phone (651) 209-8807

NPI Registry JSON

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

{
    "created_epoch": "1691712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1932882230",
    "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": "952-567-6156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 WHITEWATER DR STE 320",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439436",
            "telephone_number": "952-888-5800",
            "fax_number": "952-567-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EYE LASER & SURGERY CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-11",
        "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": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 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.