Northwest Eye Clinic, LLC

NPI #1255417002 in St. Anthony, Minnesota

Provider Information

NPI Number: 1255417002
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: 2601 39TH AVE NE STE 1
City: St. Anthony
State: Minnesota
ZIP Code: 55421
Phone: (763) 416-7600

Authorized Official

Name: KELLY PETTENGILL
Title: CREDENTIALING AND DATA MANAGEMENT
Phone: (763) 416-7629

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Ophthalmology	207W00000X	Primary

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