COLUMBIA PARK MEDICAL GROUP, PA (NPI# 1326147505) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326147505 |
| Entity Type | Organization |
| Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Other Organization Name | ANDOVER - EYEWEAR |
| Practice Address |
13819 Hanson Blvd Nw Andover MN 55304-7608 |
| Mailing Address |
6401 University Ave Ne Fridley MN 55432-4341 |
| Practice Telephone | 7635725710 |
| Practice Fax Number | 7638624415 |
| Mailing Telephone | 7635725710 |
| Mailing Fax Number | 7635713008 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-11-13 |
| Authorized Official Name | JOEN V CONDON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7635865839 |
| Is Organization Subpart | Y |
| Parent Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | EYECRAFT LAB | 21-00115 | 01 |
| MN | MEDICA EYEWARE | 21181 | 01 |
| MN | BCBS EYEWARE | 52Q42CO | 01 |
| MN | UCARE EYEWARE | 126908 | 01 |
| Other Name | Type Code |
|---|---|
| Andover - Eyewear | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497847644 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 10961 Club West Pkwy, Blaine, MN 55449-4671 | 2006-09-28 |
| 1558453787 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2006-09-28 |
| 1649370396 | Columbia Park Medical Group, Pa | Pharmacy | 10000 Zane Ave N, Suite 100, Brooklyn Park, MN 55443-1400 | 2006-09-23 |
| 1609976570 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 6341 University Ave Ne, Fridley, MN 55432-4946 | 2006-09-22 |
| 1942300801 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2006-09-22 |
| 1326148271 | Columbia Park Medical Group, Pa | Pharmacy | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1417056698 | Columbia Park Medical Group, Pa | Pharmacy | 13819 Hanson Blvd Nw, Suite 100, Andover, MN 55304-7608 | 2006-09-22 |
| 1700986668 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1619077575 | Columbia Park Medical Group, Pa | Eyewear Supplier (Equipment, not the service) | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1760589170 | Columbia Park Medical Group, Pa | Eyewear Supplier (Equipment, not the service) | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2006-09-20 |
| Street Address |
13819 HANSON BLVD NW |
| City | ANDOVER |
| State | MN |
| Zip Code | 55304-7608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881656296 | David Robert Bachman | Family Medicine | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2006-04-03 |
| 1457820912 | Jason Emold Nesler | Physician Assistant | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2018-11-14 |
| 1861999195 | Chee Lor | Family Medicine | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2018-04-12 |
| 1073013181 | Stephanie Lynn Piche | Nurse Practitioner | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2018-02-15 |
| 1326402256 | Islam Zineldin | Family Medicine | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2016-04-06 |
| 1124487624 | Joseph Aaron Gray Wilkie | Physician Assistant | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2016-02-12 |
| 1063883338 | Kelly L Nguyen | Nurse Practitioner | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2015-10-13 |
| 1881017150 | Dana Thilges | Physician Assistant | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2014-01-22 |
| 1437581824 | Tiffany N Ling | Nurse Practitioner | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2013-08-07 |
| 1518244151 | Deborah Lynn Gerdes | Counselor | 13819 Hanson Blvd Nw, Andover, MN 55304 | 2011-11-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114402211 | Sarah Sue Anderson | Speech-Language Pathologist | 1891 Station Pkwy, Andover, MN 55304 | 2018-09-25 |
| 1306354329 | Jennifer Lynn Larkey I | Counselor | 1875 Station Parkway N.w. Andover, Mn 55304, Andover, MN 55304 | 2018-01-11 |
| 1124544895 | Msp Dentistry Inc | Preferred Provider Organization | 13650 Hanson Blvd., Suite #110, Andover, MN 55304 | 2017-08-15 |
| 1912427931 | Brooke Nicole Halliday | Counselor | 1875 Station Pkwy Ne, Andover, MN 55304 | 2017-06-21 |
| 1700286903 | Jari Welle, Inc. | Marriage & Family Therapist | 1328 Mckay Drive Ne, Suite 100, Ham Lake, MN 55304 | 2014-08-26 |
| 1356765192 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 1889 139th Ave Nw, Andover, MN 55304 | 2014-02-14 |
| 1326462177 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 1899 139th Ave Nw, Andover, MN 55304 | 2014-02-14 |
| 1740619568 | Delores Weikle | Physical Therapist | 14531 Jay St, Andover, MN 55304 | 2013-11-02 |
| 1730527003 | Darkou Care Services | Home Health | 14297 Zilla Street Nw, Andover, MN 55304 | 2013-06-10 |
| 1770927758 | Arbor Oaks Senior Living | Assisted Living Facility | 1640 155th Lane Nw, Andover, MN 55304 | 2013-04-22 |
| Find all providers in zip 55304 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356524540 | Fairview Express Care | Eyewear Supplier (Equipment, not the service) | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2007-12-11 |
| 1861674665 | Fairview Health Services | Eyewear Supplier (Equipment, not the service) | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2007-12-04 |
| 1942416789 | Charles Crosby Dba Optical Department | Eyewear Supplier (Equipment, not the service) | 138 Haverhill St, Suite 104, Andover, MA 01810-1584 | 2007-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493903 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 11995 Business Park Blvd N, Champlin, MN 55316 | 2020-10-02 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1891351268 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1101 E College Dr, Marshall, MN 56258-2366 | 2019-05-11 |
| 1730745100 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1459 W Service Dr, Winona, MN 55987-2512 | 2019-05-11 |
| 1649836016 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1023 E Blue Earth Ave, Fairmont, MN 56031-4076 | 2019-05-11 |
| 1124684592 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1004 18th Ave Nw Ste D, Austin, MN 55912-1993 | 2019-05-11 |
| 1053977421 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1620 Broadway Ave S Ste 4, Rochester, MN 55904-7927 | 2019-05-11 |
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1831651165 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 3366 Oakdale Ave N Ste 140, Robbinsdale, MN 55422-2961 | 2019-04-04 |
| 1538624341 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 9825 Hospital Dr # 106, Maple Grove, MN 55369-4479 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.