1326159476 NPI number — OPTOMETRY 2000 VISION CARE INC

Table of content: (NPI 1326159476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326159476 NPI number — OPTOMETRY 2000 VISION CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTOMETRY 2000 VISION CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALBANY EYE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326159476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
471 RAILROAD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56307-9458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-845-4747
Provider Business Mailing Address Fax Number:
320-845-4885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
471 RAILROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56307-9458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-845-4747
Provider Business Practice Location Address Fax Number:
320-845-4885
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GROETSCH
Authorized Official First Name:
RICKY
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
320-845-4747

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  MN2082 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 115186 . This is a "UCARE PROV. NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5C705GR . This is a "BLUE PLUS MATERIAL PROV." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21-00018 . This is a "MEDICA MATERIALS PROV. NU" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 380225600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47576 . This is a "HEALTHPARTNERS PROV. NUM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1006663 . This is a "PREFERRED ONE PROV. NUM" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: MN2082 . This is a "EYEMED PROV. NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 410031767 . This is a "RAILROAD MEDICARE PROV." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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