Organization
PARK NICOLLET HEALTH CARE PRODUCTS
Active
Parent organization
PARK NICOLLET
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARK NICOLLET
Authorized official
KRISTIN DENISE BREY SUPERVISOR (DELEGATED OFFICIAL)
(952) 993-6832
Entity
Organization
Contact information
Practice address
EYE CARE AND OPTICAL STORE, 3900 PARK NICOLLET BLVD STE 120, ST LOUIS PARK, MN 55416-2503
(952) 993-3150
(952) 993-0562
Mailing address
PN HCP-EYE CARE AND OPTICAL STORE, 3800 PARK NICOLLET BLVD # MS 61901C, ST LOUIS PARK, MN 55416-2527
(952) 993-3150
(952) 993-0562
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21398500
—
MN
Enumeration date
04/05/2006
Last updated
09/24/2025
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