1386714616 NPI number — OPHTHALMOLOGY ASSOCIATES PA

Table of content: (NPI 1386714616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386714616 NPI number — OPHTHALMOLOGY ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPHTHALMOLOGY ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386714616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 N SMITH AVE
Provider Second Line Business Mailing Address:
RITCHIE MEDICAL PLAZA SUITE 100
Provider Business Mailing Address City Name:
ST PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102-2384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-293-0225
Provider Business Mailing Address Fax Number:
651-293-0329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 N SMITH AVE
Provider Second Line Business Practice Location Address:
RITCHIE MEDICAL PLAZA SUITE 100
Provider Business Practice Location Address City Name:
ST PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-293-0225
Provider Business Practice Location Address Fax Number:
651-293-0329
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
ERNEST
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
651-293-0225

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  20294 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23558 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1E052MI . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 105688 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30688300 . This is a "WIS MA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 11562MI . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208070X . This is a "OLD MN MA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01004516 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0802066 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0800025 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".




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