Organization
MINNEAPOLIS MEDICAL EYE CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN CHARLES FOUNTAIN (CLINIC MANAGER)
(612) 871-3611
Entity
Organization
Contact information
Practice address
710 E 24TH ST, SUITE 402, MINNEAPOLIS, MN 55404-3840
(612) 871-3611
(612) 871-7294
Mailing address
710 E 24TH ST, SUITE 402, MINNEAPOLIS, MN 55404-3840
(612) 871-3611
(612) 871-7294
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008808100
—
MN
Enumeration date
08/25/2006
Last updated
08/20/2008
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