Organization
OPHTHALMOLOGY PA
Active
Other names
McCannel Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA LOUISE BERG (BUSINESS OFFICE)
(952) 848-8383
Entity
Organization
Contact information
Practice address
3100 W 70TH ST, EDINA, MN 55435-4227
(952) 848-8300
(952) 848-8313
Mailing address
3100 W 70TH ST, EDINA, MN 55435-4227
(952) 848-8300
(952) 848-8313
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0026007
MN
332H00000X
Eyewear Supplier
0026007
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130790P
BLUE SHIELD OF MINNESOTA
MN
01
—
156
HEALTH PARTNERS
MN
05
—
585010000
—
MN
01
—
CP4332
RAILROAD MEDICARE
MN
01
—
D044
UCARE MINNESOTA
MN
Enumeration date
06/09/2005
Last updated
05/01/2026
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