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OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY P.A. NPI 1386716157


NPI Information

NPI: 1386716157
Provider Name: OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY, P.A.
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
4887 E LAKE HARRIET BLVD
MINNEAPOLIS, MN
ZIP 55419
Phone: (612) 325-0317
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OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY, P.A. is a specialist in Minneapolis, MN. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY, P.A. NPI is 1386716157. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4887 E LAKE HARRIET BLVD
MINNEAPOLIS, MN
ZIP 55419-222
Phone: (612) 325-0317

The provider's authorized official is Richard P Carroll .
The authorized official title is President/owner and has the following contact phone number (612) 325-0317.

The enumeration date for this NPI number is 11/15/2006 and was last updated on 4/27/2010.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist799MINNESOTAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
116176MEDICAIDNORTH DAKOTA
226128OPOTHERMINNESOTABLUE CROSS BLUE SHIELD MN
3=========OTHERMINNESOTAFEDERAL TAX ID
495322OTHERMINNESOTAHEALTH PARTNERS
5031010700MEDICAIDMINNESOTA
6C01166MEDICARE PINMINNESOTA
7122169D805OTHERMINNESOTAUCARE MINNESOTA
80802163OTHERMINNESOTAMEDICA
97787270MEDICAIDSOUTH DAKOTA
1031260500MEDICAIDWISCONSIN
11CP2368MEDICARE PINGEORGIA
12CP2456MEDICARE PINGEORGIA

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.