1609897594 NPI number — LITTLE FALLS EYE CARE CENTER P.A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609897594 NPI number — LITTLE FALLS EYE CARE CENTER P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE FALLS EYE CARE CENTER P.A
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:
Provider Other Organization Name Type Code:
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:
1609897594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 1ST ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56345-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-632-3676
Provider Business Mailing Address Fax Number:
320-632-3677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 1ST ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56345-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-632-3676
Provider Business Practice Location Address Fax Number:
320-632-3677
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINDERSCHIED
Authorized Official First Name:
TIM
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
320-632-3676

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 167238E979 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21-16068 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 586062800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1099200001 . This is a "ADMINISTAR DMERC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41074 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C998LI . This is a "BCBS EYEGLASSES" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: DC1861 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0005852588 . This is a "AETNA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01006331 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C929LI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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