1396817953 NPI number — MIDWEST VISION CENTERS INC

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 1396817953 NPI number — MIDWEST VISION CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST VISION CENTERS 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:
6
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:
1396817953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56302-0456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-466-5777
Provider Business Mailing Address Fax Number:
320-258-3136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED WING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55066-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-388-0738
Provider Business Practice Location Address Fax Number:
651-388-0739
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOSO
Authorized Official First Name:
PATRICE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
INSURANCE COORDINATOR
Authorized Official Telephone Number:
888-466-5777

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 281R6MI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2100332 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 98394 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 163961 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 23180 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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