Provider Demographics
NPI:1487706073
Name:EDA, INC
Entity type:Organization
Organization Name:EDA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-560-1636
Mailing Address - Street 1:5515 XERXES AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2856
Mailing Address - Country:US
Mailing Address - Phone:763-560-1636
Mailing Address - Fax:763-560-4101
Practice Address - Street 1:5515 XERXES AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2856
Practice Address - Country:US
Practice Address - Phone:763-560-1636
Practice Address - Fax:763-560-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1068294156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1720056641OtherHEALTHPARTNERS
MN298N0PEOtherBCBS
MNPE1512552OtherCLARITY VISION
MN21-20195OtherMEDICA-UHC
MN2120195OtherMEDICA
MN781138100Medicaid
MNPE1512552OtherCLARITY VISION
MN781138100Medicaid