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Organization
EYEWEAR SPECIALISTS
Active
Organization
EYEWEAR SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHERYL MAYNE (RCM MANAGER)
(952) 832-8100
Entity
Organization
Contact information
Practice address
4201 DEAN LAKES BLVD, SUITE 100, SHAKOPEE, MN 55379-2829
(952) 445-5763
(952) 233-3029
Mailing address
7450 FRANCE AVE S, SUITE 100, EDINA, MN 55435-4787
(952) 832-8120
(952) 832-8124
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
4699580
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-27952
MEDICA
MN
01
—
51083CL
BCBS
MN
05
—
6944973-00
—
MN
Enumeration date
11/01/2006
Last updated
06/16/2016
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