Northwest Eye Clinic, LLC
NPI #1164508917 in Maple Grove, Minnesota
Provider Information
- NPI Number
- 1164508917
- Entity Type
- Organization
- Organization Name
- Northwest Eye Clinic, LLC
- Primary Specialty
- Ophthalmology
- Enumeration Date
- Oct 27, 2006
- Last Updated
- Mar 18, 2020
Practice Location
- Address
- 12000 ELM CREEK BLVD N STE 100
- City
- Maple Grove
- State
- Minnesota
- ZIP Code
- 55369-7074
- Phone
- (763) 416-7600
Authorized Official
- Name
- KELLY PETTENGILL
- Title
- CREDENTIALING AND DATA MANAGEMENT
- Phone
- (763) 416-7629
Specialties & Taxonomy Codes
| Specialty |
|---|
| Ophthalmology |
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