Organization
LAKEVILLE FAMILY EYE CARE LLC
Active
Parent organization
SOUTH SUBURBAN EYE CARE SPECIALISTS PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH SUBURBAN EYE CARE SPECIALISTS PA
Authorized official
DR. ANDREW JOSEPH MATTSON O.D. (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
2823
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518037563
NPI
MN
01
—
202779692
VSP
MN
01
—
2203175
UNITED HEALTH CARE
MN
01
—
2823
MN LICENSE
MN
01
—
499R7LA
BLUE CROSS BLUE SHIELD MN
MN
01
—
A61971031584
PREFERRED ONE
MN
01
—
HP36326
HEALTHPARTNERS
MN
Enumeration date
04/24/2009
Last updated
03/07/2023
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