Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
Parent organization
COLUMBIA PARK MEDICAL GROUP
Other names
Fridley Plaza - Eyeware
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLUMBIA PARK MEDICAL GROUP
Authorized official
JOEN V CONDON (CHIEF FINANCIAL OFFICER)
(763) 586-5839
Entity
Organization
Contact information
Practice address
6341 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4946
(763) 572-5718
(763) 572-0318
Mailing address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126906
UCARE EYEWARE
MN
01
—
21-00011
EYECRAFT LAB
MN
01
—
21140
MEDICA EYEWARE
MN
01
—
5C734CO
BCBS EYEWARE
MN
Enumeration date
09/20/2006
Last updated
11/13/2007
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up