Organization
COLUMBIA PARK MEDICAL GROUP, PA
Active
Parent organization
COLUMBIA PARK MEDICAL GROUP, PA
Other names
Brooklyn Park - Eyeware
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLUMBIA PARK MEDICAL GROUP, PA
Authorized official
JOEN V CONDON (CHIEF FINANCIAL OFFICER)
(763) 586-5839
Entity
Organization
Contact information
Practice address
10000 ZANE AVE N, BROOKLYN PARK, MN 55443-1400
(763) 572-5710
(763) 569-6200
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
—
08316
MEDICA EYEWARE
MN
01
—
102326
UCARE EYEWARE
MN
01
—
21-08316
EYECRAFT LAB
MN
01
—
5C727CO
BCBS EYEWARE
MN
Enumeration date
09/20/2006
Last updated
11/13/2007
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