Provider Demographics
NPI:1144264995
Name:EDINA RETINA CONSULTANTS
Entity type:Organization
Organization Name:EDINA RETINA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-345-8200
Mailing Address - Street 1:6525 FRANCE AVE S STE 115
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2283
Mailing Address - Country:US
Mailing Address - Phone:952-345-8200
Mailing Address - Fax:
Practice Address - Street 1:6525 FRANCE AVE S STE 115
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2283
Practice Address - Country:US
Practice Address - Phone:952-345-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04284Medicare PIN
MNG36681Medicare UPIN