1821143728 NPI number — HATAYE-SOFTING OPTOMETRISTS, LTD.

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 1821143728 NPI number — HATAYE-SOFTING OPTOMETRISTS, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HATAYE-SOFTING OPTOMETRISTS, LTD.
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:
INNOVISION EYECARE
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:
1821143728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 S BROADWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBERT LEA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56007-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-373-0627
Provider Business Mailing Address Fax Number:
507-373-0628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 S BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBERT LEA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56007-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-373-0627
Provider Business Practice Location Address Fax Number:
507-373-0628
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HATAYE
Authorized Official First Name:
GARETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
507-373-0627

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2189 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 2212 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2200450 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 409523500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4C068SO . This is a "BCBSM ALAINA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 122609 . This is a "UCARE ALAINA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1011298 . This is a "PREFERRED ONE ALAINA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 115713 . This is a "UCARE GARETH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 169323900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011297 . This is a "PREFERRED ONE GARETH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C070PA . This is a "BCBSM OPTICAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2200104 . This is a "MEDICA OPTICAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C067PA . This is a "BCBSM GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 123247 . This is a "UCARE GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C069HA . This is a "BCBSM GARETH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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