Organization
EDA, INC
Active
Other names
PEARLE VISION
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON KING (CFO)
(763) 560-1636
Entity
Organization
Contact information
Practice address
5515 XERXES AVE N, BROOKLYN CENTER, MN 55430-2856
(763) 560-1636
(763) 560-4101
Mailing address
5515 XERXES AVE N, BROOKLYN CENTER, MN 55430-2856
(763) 560-1636
(763) 560-4101
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1068294
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720056641
HEALTHPARTNERS
MN
01
—
21-20195
MEDICA-UHC
MN
01
—
2120195
MEDICA
MN
01
—
298N0PE
BCBS
MN
05
—
781138100
—
MN
01
—
PE1512552
CLARITY VISION
MN
Enumeration date
01/17/2007
Last updated
05/04/2009
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