Organization
EYEWEARSPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHERYL MAYNE (RCM MANAGER)
(952) 832-8100
Entity
Organization
Contact information
Practice address
111 HUNDERTMARK RD, SUITE 105N, CHASKA, MN 55318-4551
(952) 906-7824
(952) 906-7827
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
05
—
1251147-00
—
MN
01
—
170631
UCARE
MN
01
—
21-00712
MEDICA
MN
01
—
51083CL
BCBS
MN
Enumeration date
11/06/2006
Last updated
06/16/2016
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