COLUMBIA PARK MEDICAL GROUP PA NPI 1205933611

NPI Information

  • NPI: 1205933611
  • Provider Name: COLUMBIA PARK MEDICAL GROUP, PA
  • Classification: Eyewear Supplier - 332H00000X
  • Entity Type: Organization
  • Other Name: FRIDLEY PLAZA - EYEWARE
  • Address: 6341 UNIVERSITY AVE NE
    FRIDLEY, MN
    ZIP 55432
  • Phone: (763) 572-5718

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NPI Details

COLUMBIA PARK MEDICAL GROUP, PA is an eyewear supplier in Fridley, MN. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. COLUMBIA PARK MEDICAL GROUP, PA NPI is 1205933611. The provider is registered as an organization entity type.
The provider Other Name Is Fridley Plaza - Eyeware.

The provider's business location address is:

6341 UNIVERSITY AVE NE
FRIDLEY, MN
ZIP 55432-946
Phone: (763) 572-5718
Fax: (763) 572-0318

The provider's authorized official is Joen V Condon .
The authorized official title is Chief Financial Officer and has the following contact phone number (763) 586-5839.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 11/13/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332H00000XEyewear SupplierMINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
121140OTHERMINNESOTAMEDICA EYEWARE
25C734COOTHERMINNESOTABCBS EYEWARE
321-00011OTHERMINNESOTAEYECRAFT LAB
4126906OTHERMINNESOTAUCARE EYEWARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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