1457357071 NPI number — VISUAL EDGE, INC

Table of content: (NPI 1457357071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457357071 NPI number — VISUAL EDGE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISUAL EDGE, INC
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:
PEARLE VISION
Provider Other Organization Name Type Code:
3
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:
1457357071
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:
3333 HAZELTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-926-5300
Provider Business Mailing Address Fax Number:
952-915-9212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 HAZELTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-926-6149
Provider Business Practice Location Address Fax Number:
952-926-2729
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZWEBER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
952-345-5044

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  1068294 , 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: 102075 . This is a "COLE MANAGED VISION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21-20194 . This is a "MEDICA/UNITED HEALTHCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0626900005 . This is a "MEDICARE DMERC REGION B" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 65160PE . This is a "BCBS VISION EXAMS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: PE1512548 . This is a "CLARITY VISION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 65161PE . This is a "BCBS EYEWEAR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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