SOUTHDALE OPTICAL CO (NPI# 1871576306) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871576306 |
| Entity Type | Organization |
| Organization Name | SOUTHDALE OPTICAL CO |
| Practice Address |
6533 Drew Ave S Edina MN 55435-2103 |
| Practice Telephone | 9529259550 |
| Practice Fax Number | 9529259748 |
| Mailing Telephone | 9529259550 |
| Mailing Fax Number | 9529259748 |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2009-06-16 |
| Authorized Official Name | MR. BRADLEY JON PETERSON (PRESIDENT) |
| Authorized Official Telephone | 9529259550 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Street Address |
6533 DREW AVE S |
| City | EDINA |
| State | MN |
| Zip Code | 55435-2103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568880755 | Raymond C Croissant Md Pa | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2014-04-03 |
| 1609103209 | Horn Ophthalmology Inc | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2009-11-03 |
| 1578755872 | Peter Mellema | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2007-08-10 |
| 1376747808 | Leslie W. Jacobson, Md Pa | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2007-06-11 |
| 1649242918 | Jonathan H Engman | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2006-02-02 |
| 1184609646 | Nathan Buth Reader | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435 | 2005-12-07 |
| 1467436477 | Martin Berk Kaplan | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2005-12-02 |
| 1538143516 | Mark Lewis Norman IIi | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2005-12-02 |
| 1114901543 | Dorothy Jeanne Horns | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2005-11-30 |
| 1083698419 | Raymond Charles Croissant | Ophthalmology | 6533 Drew Ave S, Edina, MN 55435-2103 | 2005-11-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104433416 | Evy Christine Claussen | Social Worker | 6363 France Ave. S., Edina, MN 55435 | 2020-09-30 |
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1730651639 | Taylor Lee Kehoe | Physician Assistant | 7400 France Ave., Suite #100, Edina, MN 55435 | 2018-12-18 |
| 1538666326 | Amanda Deangelo | Physical Therapist | 6401 Southdale Hospital, Ll3g, Edina, MN 55435 | 2018-04-09 |
| 1982107876 | Julia Seliber | Dental Hygienist | 7600 France Ave.s. Suite 1100, Edina, MN 55435 | 2018-03-16 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1730605528 | Edina Medical Supplies | Durable Medical Equipment & Medical Supplies | 7455 France Ave., #614 S, Edina, MN 55435 | 2017-08-14 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1306206321 | Barb Ryan | Mechanotherapist | 7550 France Avenue S, #220, Edina, MN 55435 | 2016-03-03 |
| Find all providers in zip 55435 | ||||
| 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 |
|---|---|---|---|---|
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1396265716 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 100 Southdale Ctr, Edina, MN 55435-2403 | 2017-06-27 |
| 1801163191 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 1045 Southdale Ctr, Edina, MN 55435-7050 | 2011-11-30 |
| 1700024437 | Jay Mar Opticians, Inc | Eyewear Supplier (Equipment, not the service) | 6545 France Ave So, Suite 605, Edina, MN 55435-2117 | 2009-02-03 |
| 1902092158 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 7000 York Ave, Edina, MN 55435-4213 | 2007-09-21 |
| 1558415786 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 2195 Southdale S/c, Edina, MN 55435-7065 | 2007-01-23 |
| 1770668675 | Vision World Inc | Eyewear Supplier (Equipment, not the service) | 1030 Southdale Center, Edina, MN 55435 | 2006-10-26 |
| 1114921996 | Ophthalmology Pa | Eyewear Supplier (Equipment, not the service) | 3100 W 70th St, Edina, MN 55435-4227 | 2005-06-09 |
| 1962829580 | Minnesota Optical LLC | Eyewear Supplier (Equipment, not the service) | 3333 Hazelton Rd, Edina, MN 55435-4204 | 2014-03-20 |
| 1750613188 | Pearle Vision Inc | Eyewear Supplier (Equipment, not the service) | 3333 Hazelton Rd, Yorktown Mall, Edina, MN 55435-4204 | 2010-02-10 |
| Find all providers in EDINA | ||||
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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.