MINNESOTA EYE LASER & SURGERY CENTERS, LLC (NPI# 1619957115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619957115 |
| Entity Type | Organization |
| Organization Name | MINNESOTA EYE LASER & SURGERY CENTERS, LLC |
| Practice Address |
1965 11th Ave E Maplewood MN 55109-5167 |
| Mailing Address |
9801 Dupont Ave S Suite 425 Bloomington MN 55431-3100 |
| Practice Telephone | 9528885800 |
| Practice Fax Number | 6517484401 |
| Mailing Telephone | 9528885800 |
| Mailing Fax Number | 9525676156 |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2017-02-22 |
| Authorized Official Name | BRENT L WILDE (COO-PRESIDENT) |
| Authorized Official Telephone | 9525676143 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QS0132X |
Clinic/Center Specialization: Ophthalmologic Surgery |
Ambulatory Health Care Facilities | ||
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
330696 | MN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 548339500 | 05 | |
| MN | CLIA | 24D1047154 | 01 |
| MN | RR MEDICARE | P00296022 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578003208 | Minnesota Eye Laser & Surgery Centers, LLC | Clinic/Center | 7125 Tamarack Rd Ste 200, Woodbury, MN 55125-1308 | 2017-02-28 |
| 1316379647 | Minnesota Eye Laser & Surgery Centers, LLC | Clinic/Center | 10709 Wayzata Blvd, Suite 100, Minnetonka, MN 55305-5509 | 2013-08-09 |
| 1205152618 | Minnesota Eye Laser & Surgery Centers, LLC | Clinic/Center | 11091 Ulysses Street Ne, Suite 400, Blaine, MN 55434-4237 | 2010-04-09 |
| 1720059421 | Minnesota Eye Laser & Surgery Centers, LLC | Clinic/Center | 9801 Dupont Ave S, Suite 100, Bloomington, MN 55431-3100 | 2006-01-30 |
| Street Address |
1965 11TH AVE E |
| City | MAPLEWOOD |
| State | MN |
| Zip Code | 55109-5167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861465064 | Minnesota Eye Consultants, Pa | Optometrist | 1965 11th Ave E, Suite 102, Maplewood, MN 55109-5167 | 2006-02-08 |
| 1033473343 | Ashley Herde | Optometrist | 1965 11th Ave E, Suite 101, Maplewood, MN 55109-5167 | 2012-07-02 |
| 1730203597 | Optometric Eye Care Centers, Pa | Optometrist | 1965 11th Ave E, Suite 101, Maplewood, MN 55109-5167 | 2007-03-19 |
| 1922058247 | Bradley D Richter | Optometrist | 1965 11th Ave E, Maplewood, MN 55109-5167 | 2006-05-10 |
| 1407806763 | Mitchell H Albers | Optometrist | 1965 11th Ave E, Maplewood, MN 55109-5167 | 2006-05-10 |
| 1326096686 | Gregory W Kraupa | Optometrist | 1965 11th Ave E, Maplewood, MN 55109-5167 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063828 | Jodi May Begordis | Registered Nurse | 2586 7th Ave East, Suite 302, North St Paul, MN 55109 | 2020-05-06 |
| 1467917146 | Alejandro Diez Freire | Social Worker | 2468 Germain St, Maplewood, MN 55109 | 2019-02-06 |
| 1679099667 | Rochelle Marie Clarke | Registered Nurse | 2586 7th Ave East Suite 302, North Saint Paul, MN 55109 | 2017-08-21 |
| 1497298210 | Salams Care Residential, LLC | Home Health | 2240 Ide Ct, Maplewood, MN 55109 | 2016-11-28 |
| 1093199630 | Garry Allen | Psychologist | 2345 Ariel St North Mail Stop 13601a, Maplewood, MN 55109 | 2015-07-14 |
| 1700264751 | Matthew Seng Thao | Student in an Organized Health Care Education/Training Program | 1470 Gervais Ave, Maplewood, MN 55109 | 2015-05-11 |
| 1326458340 | Chong Chang | Counselor | 1705 Cope Ave E Ste I, Maplewood, MN 55109 | 2014-04-29 |
| 1619396488 | Leah Anne Downey | Occupational Therapist | 2399 Ariel St. N., Children's Theraplay, LLC, Maplewood, MN 55109 | 2014-04-09 |
| 1356765440 | Group Health Plan, Inc | Clinic/Center | 2520 12th Ave E, North St Paul, MN 55109 | 2014-02-10 |
| 1336560275 | Veneman Dental Care, Pa | Dentist | 1774 Cope Ave, Suite 110, Maplewood, MN 55109 | 2013-12-19 |
| Find all providers in zip 55109 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992763932 | Healtheast Surgery Center-maplewood, LLC | Clinic/Center | 2945 Hazelwood St Ste 300, Maplewood, MN 55109-1244 | 2006-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669079992 | Woodbury Surgery Center, LLC | Clinic/Center | 587 Bielenberg Dr Ste 100, Woodbury, MN 55125-4452 | 2020-10-09 |
| 1902410368 | Inspired Spine Surgcenter LLC | Clinic/Center | 7400 France Ave S Ste 102, Edina, MN 55435-4738 | 2020-09-03 |
| 1508480427 | El Solutions LLC | Clinic/Center | 445 Minnesota St., Ste. 1500 12, St. Paul, MN 55101 | 2020-06-05 |
| 1215573209 | Hiawatha Surgery Center LLC | Clinic/Center | 2020 E 28th St Ste 100, Minneapolis, MN 55407-1453 | 2019-11-25 |
| 1346808714 | Vance Thompson Vision Surgery Center Alexandria, Prof LLC | Clinic/Center | 2600 Jefferson St, Alexandria, MN 56308 | 2019-05-31 |
| 1942760285 | Altru Health System Ambulatory Surgery Centers LLC | Clinic/Center | 400 S Minnesota St Ste B, Crookston, MN 56716-1808 | 2019-03-22 |
| 1396229746 | Avera Marshall | Clinic/Center | 1521 Carlson St Ste 200, Marshall, MN 56258-2626 | 2018-09-21 |
| 1891297925 | Pediatric Center Holdings, LLC | Clinic/Center | 15450 Highway 7 Ste 200, Minnetonka, MN 55345-3522 | 2018-03-05 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1922526961 | Blaine Asc, LLC | Clinic/Center | 11225 Ulysses Street Northeast, Blaine, MN 55434 | 2017-08-30 |
| 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.