Organization
EYEWEAR SPECIALISTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHERYL MAYNE (RCM MANAGER)
(952) 832-8100
Entity
Organization
Contact information
Practice address
14050 NICOLLET AVE, SUITE 101, BURNSVILLE, MN 55337-5710
(952) 898-6223
(952) 898-8832
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
—
0237019-00
—
MN
01
—
21-12085
MEDICA
MN
01
—
51083CL
BCBS
MN
Enumeration date
11/01/2006
Last updated
06/16/2016
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