Organization
NORTHWEST EYE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY PETTENGILL (CREDENTIALING AND DATA MANAGEMENT)
(763) 416-7629
Entity
Organization
Contact information
Practice address
8501 GOLDEN VALLEY RD STE 100, GOLDEN VALLEY, MN 55427-4472
(763) 416-7600
(763) 416-7634
Mailing address
8401 GOLDEN VALLEY RD STE 330, GOLDEN VALLEY, MN 55427-4488
(763) 416-7629
(763) 383-4147
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
360
MN
Other
Enumeration date
02/04/2013
Last updated
03/18/2020
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