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7415 Wayzata Blvd, St Louis Park, MN 55426-1607 | |
(952) 475-3787 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Ophthalmology |
Location | 7415 Wayzata Blvd, St Louis Park, Minnesota |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1780696146 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (Minnesota) | Secondary |
207W00000X | Ophthalmology | (Minnesota) | Primary |
Provider Name | Jabin G Krassin |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1801092960 PECOS PAC ID: 6608935648 Enrollment ID: I20081106000155 |
Provider Name | David W Whiting |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1003836479 PECOS PAC ID: 9234023482 Enrollment ID: I20081218000667 |
Provider Name | Nathan P Langemo |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1316272495 PECOS PAC ID: 2466604400 Enrollment ID: I20121220000193 |
Provider Name | Kasie Jean Mix |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1407109275 PECOS PAC ID: 9931410727 Enrollment ID: I20150619001796 |
Mailing Address | Practice Location Address |
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7415 Wayzata Blvd, St Louis Park, MN 55426-1607 Ph: (952) 475-3787 | 7415 Wayzata Blvd, St Louis Park, MN 55426-1607 Ph: (952) 475-3787 |