1265659577 NPI number — MIDWEST EYE LABORATORIES INC

Table of content: (NPI 1265659577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265659577 NPI number — MIDWEST EYE LABORATORIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST EYE LABORATORIES 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:
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:
1265659577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4606 COMMERCE VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54701-7075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-833-2277
Provider Business Mailing Address Fax Number:
715-833-2295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 2ND AVE SW
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55902-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-833-2277
Provider Business Practice Location Address Fax Number:
715-833-2295
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARRETT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT OCULARIST
Authorized Official Telephone Number:
715-833-2277

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265659577 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1265659577 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 866458700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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