Provider Demographics
NPI:1194290486
Name:EYE CARE ASSOCIATES, PA
Entity type:Organization
Organization Name:EYE CARE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-338-4861
Mailing Address - Street 1:825 NICOLLET MALL STE 2000
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2708
Mailing Address - Country:US
Mailing Address - Phone:612-338-4861
Mailing Address - Fax:612-333-8306
Practice Address - Street 1:710 E 24TH ST STE 101-201
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3840
Practice Address - Country:US
Practice Address - Phone:612-871-0100
Practice Address - Fax:612-871-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty