Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
Other names
Columbia Park - Eyeware
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LOUIS WEIR (EXECUTIVE DIRECTOR)
(763) 586-5877
Entity
Organization
Contact information
Practice address
4000 CENTRAL AVE NE, COLUMBIA HEIGHTS, MN 55421-2968
(763) 572-5710
(763) 782-8100
Mailing address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126907
UCARE EYEWARE
MN
01
—
21-00010
EYECRAFT LAB
MN
01
—
21139
MEDICA EYEWARE
MN
01
—
5C728CO
BCBS EYEWARE
MN
Enumeration date
09/22/2006
Last updated
08/22/2020
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