Organization
EAGAN EYE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY SHORT (CREDENTIALING MANAGER)
(618) 462-9818
Entity
Organization
Contact information
Practice address
3930 CEDAR GROVE PKWY, EAGAN, MN 55122-1403
(651) 454-5661
(651) 454-5669
Mailing address
3930 CEDAR GROVE PKWY, EAGAN, MN 55122-1403
(651) 454-5661
(651) 454-5669
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271775100
—
MN
Enumeration date
10/29/2007
Last updated
07/07/2020
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