Organization
OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD P CARROLL M.D. (PRESIDENT/OWNER)
(612) 325-0317
Entity
Organization
Contact information
Practice address
4887 E LAKE HARRIET BLVD, MINNEAPOLIS, MN 55419-5222
(612) 325-0317
Mailing address
4887 E LAKE HARRIET BLVD, MINNEAPOLIS, MN 55419-5222
(612) 325-0317
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
799
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031010700
—
MN
01
—
0802163
MEDICA
MN
01
—
122169D805
UCARE MINNESOTA
MN
05
—
16176
—
ND
01
—
26128OP
BLUE CROSS BLUE SHIELD MN
MN
05
—
31260500
—
WI
05
—
7787270
—
SD
01
—
95322
HEALTH PARTNERS
MN
Enumeration date
11/15/2006
Last updated
04/27/2010
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