Organization
PROGRESSIVE EYECARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA L KENT (PRACTICE ADMINISTRATOR)
(651) 645-3997
Entity
Organization
Contact information
Practice address
4625 CHURCHILL STREET, SUITE 210, SHOREVIEW, MN 55126
(651) 645-3997
Mailing address
1690 UNIVERSITY AVE WEST, SUITE 140, ST PAUL, MN 55104
(651) 645-3997
(651) 641-7207
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
776
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0461340002
DMERC
—
01
—
CS0820
RAILROAD MEDICARE
—
Enumeration date
05/11/2007
Last updated
08/22/2020
Update your record
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