Organization
SOUTH SUBURBAN EYECARE SPECIALISTS PA
Active
Other names
Lakeville Family Eye Care PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW JOSEPH MATTSON OD (PRESIDENT)
(952) 898-9588
Entity
Organization
Contact information
Practice address
17690 KENWOOD TRL, LAKEVILLE, MN 55044-9764
(952) 898-9588
(952) 898-2030
Mailing address
17690 KENWOOD TRL, LAKEVILLE, MN 55044-9764
(952) 898-9588
(952) 898-2030
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113428
HEALTH PARTNERS
MN
05
—
176625200
—
MN
01
—
2203175
UNITED HEALTH CARE
MN
01
—
499R7LA
BLUE CROSS BLUE SHIELD MN
MN
01
—
79G34LA
BLUE PLUS
MN
01
—
A61971031584
PREFERRED ONE
MN
Enumeration date
06/06/2007
Last updated
06/02/2011
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