Provider Demographics
NPI:1124133764
Name:FOLEY, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:FOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 HIGHWAY 55
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2156
Mailing Address - Country:US
Mailing Address - Phone:651-842-3328
Mailing Address - Fax:651-842-3391
Practice Address - Street 1:1570 CONCORDIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4548
Practice Address - Country:US
Practice Address - Phone:651-287-2020
Practice Address - Fax:651-294-2020
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43920207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180001530OtherMEDICARE - FOLEY EYE
MN0800622OtherMEDICA
MN180042491OtherMEDICARE - PRO EYE
MN742678000Medicaid
180042491OtherRR MEDICARE
MN52F33FOOtherBLUE CROSS
MN742678000Medicaid