EDINA EYE PHYSICIANS AND SURGEONS PA
NPI 1114124971
Clinic/Center - Medical Specialty in Blaine, MN
NPI Status: Active since June 27, 2007
Contact Information
11855 ULYSSES ST
SUITE 140
BLAINE, MN
ZIP 55434
Phone: (763) 421-7420
Fax: (763) 421-0730
- Organization
- Clinic/Center
- Medical Specialty
- Accepts Insurance
- CLIA Number: 24D1071778
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 01-13-2028
About EDINA EYE PHYSICIANS AND SURGEONS PA
This page provides the complete NPI Profile along with additional information for Edina Eye Physicians And Surgeons Pa, a provider established in Blaine, Minnesota operating as a Clinic/center, focusing in medical specialty . The healthcare provider is registered in the NPI registry with number 1114124971 assigned on June 2007. The practitioner's primary taxonomy code is 261QM2500X. The provider is registered as an organization and their NPI record was last updated January 2026. The authorized official of this NPI record is Delta Jorgensen (Practice Administrator)
- NPI
- 1114124971
- Provider Name
- EDINA EYE PHYSICIANS AND SURGEONS PA
- Entity Type
- Organization
- Location Address
- 11855 ULYSSES ST SUITE 140 BLAINE, MN 55434
- Location Phone
- (763) 421-7420
- Location Fax
- (763) 421-0730
- Mailing Address
- 3777 COON RAPIDS BLVD NW STE 100 COON RAPIDS, MN 55433
- Mailing Phone
- (612) 999-2020
- Mailing Fax
- (763) 421-0730
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-27-2007
- Last Update Date
- 01-28-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Medical Specialty
- Taxonomy Code
- 261QM2500X
- Type
- Ambulatory Health Care Facilities
- License State
- MN
- Taxonomy Description
- An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Atlas $1,300 Gold - PPO
- Atlas $2,000 Standard Gold - PPO
- Atlas $3,050 Plus Silver - PPO
- Atlas $3,800 HSA Silver - PPO
- Atlas $6,000 Standard Silver - PPO
- Atlas $6,800 Plus Bronze HSA - PPO
- Atlas $7,500 Standard Bronze HSA - PPO
- Atlas $8,400 HSA Bronze - PPO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze Share - HMO
- Medica Individual Choice Expanded Bronze Standard - HMO
- Medica Individual Choice Gold $0 Copay PCP Visits - HMO
- Medica Individual Choice Gold Share - HMO
- Medica Individual Choice Gold Standard - HMO
- Medica Individual Choice Silver $0 Copay PCP Visits - HMO
- Medica Individual Choice Silver Share - HMO
- Medica Individual Choice Silver Standard - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D1071778
- Facility Type
- Physician Office
- Certificate Effective Date
- January 14, 2026
- Certificate Expiration Date
- January 13, 2028
- Laboratory Director
- JEFFERY J. STEPHENS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Edina Eye Physicians And Surgeons Pa to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1114124971, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114124971, enumerated as an "organization" on June 27, 2007.
The provider is located at 11855 ULYSSES ST SUITE 140 BLAINE, MN 55434 and the phone number is (763) 421-7420.
Clinic/Center with taxonomy code 261QM2500X and a focus in Medical Specialty.
The provider might be accepting Accepts: HealthPartners and Medica. Please consult your insurance carrier or call the provider to verify.
