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Organization

NORTHWEST EYE CLINIC, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AUDREY IRENE BERG (BUSINESS OFFICE SUPERVISOR)
(763) 383-4140
Entity
Organization

Contact information

Practice address
5657 DULUTH ST, GOLDEN VALLEY, MN 55422-4054
(763) 416-7600
(763) 542-9708
Mailing address
8401 GOLDEN VALLEY RD, SUITE 330, GOLDEN VALLEY, MN 55427-4486
(763) 383-4130
(763) 383-4147

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
360
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
290445400
MN
Enumeration date
10/27/2006
Last updated
01/22/2009
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