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1304 4th St Se, Minneapolis, MN 55414-2029 | |
| (612) 331-7100 | |
| (612) 331-7100 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 1304 4th St Se, Minneapolis, Minnesota |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780823070 | NPI | - | NPPES |
| 165105600 | Medicaid | MN | |
| 972N3ME | Other | BLUE CROSS BLUE SHIELD (MATERIALS) | |
| 2115817 | Other | MEDICA | |
| 354K1ME | Other | BLUE CROSS BLUE SHIELD (EXAMS) | |
| 126892 | Other | HEALTH PARTNERS | |
| 165577 | Other | UCARE MINNESOTA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | MN1582 (Minnesota) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
101 5th St E Ste 281, Saint Paul, MN 55101-1862 Ph: (651) 227-6506 | 1304 4th St Se, Minneapolis, MN 55414-2029 Ph: (612) 331-7100 |
Dr. Xuanmai Thi Ta, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 2718 Nicollet Ave, Suite No. 103, Minneapolis, MN 55408 Phone: 612-871-1518 Fax: 612-871-2585 | |
Dr. Theodore Lester Hansen, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 115 East Lake St, Minneapolis, MN 55408 Phone: 612-827-3857 Fax: 612-827-7204 | |
Kari Maffitt, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 3553 Hennepin Ave, Minneapolis, MN 55408 Phone: 612-822-5844 Fax: 612-827-3418 | |
Dr. David Paul Parupsky, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1304 4th St Se, Dinkytown Optical, Minneapolis, MN 55414 Phone: 612-331-7100 Fax: 612-331-7100 | |
Moulay Younes Elidrissi, Optometrist Medicare: Not Enrolled in Medicare Practice Location: 720 W Lake St # 107, Minneapolis, MN 55408 Phone: 612-216-4705 |