Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ophthalmic Plastic and Reconstructive Surgery, PA

Organization Specialist · NPI 1386716157

Ophthalmic Plastic and Reconstructive Surgery, PA is a Specialist in Minneapolis, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4887 E Lake Harriet Blvd
Minneapolis, MN 55419-5222
Phone: (612) 325-0317
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 799 (MN)

Record details

NPI number1386716157
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Richard Carroll — President/Owner · (612) 325-0317
NPI enumeratedNovember 15, 2006
Last updated in NPPESApril 27, 2010
Mailing address4887 E Lake Harriet Blvd, Minneapolis, MN 55419-5222

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