| Southside Vision Clinic | |
|
4243 4th Ave S Minneapolis MN 55409-2113 | |
| (612) 822-9030 | |
| (612) 821-2818 |
| Full Name | Southside Vision Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 4243 4th Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | William Henry Tendle (EXECUTIVE DIRECTOR-CEO) |
| Authorized Official Contact | 6128212800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Vision Clinic 4243 4th Ave S Minneapolis MN 55409-2113 Ph: (612) 821-2799 | Southside Vision Clinic 4243 4th Ave S Minneapolis MN 55409-2113 Ph: (612) 822-9030 |
| NPI Number | 1679690952 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 04/30/2014 |
| Medicare PECOS PAC ID | 8921027228 |
|---|---|
| Medicare Enrollment ID | O20100622000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679690952 | NPI | - | NPPES |
| 515753600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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