Provider Demographics
NPI:1588903512
Name:CAMBRIDGE EYE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:CAMBRIDGE EYE ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-689-1494
Mailing Address - Street 1:6063 MAIN ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6699
Mailing Address - Country:US
Mailing Address - Phone:651-674-4735
Mailing Address - Fax:651-674-8002
Practice Address - Street 1:6063 MAIN ST
Practice Address - Street 2:UNIT 5
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6699
Practice Address - Country:US
Practice Address - Phone:651-674-4735
Practice Address - Fax:651-674-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty