1801819941 NPI number — RIVERTOWN EYE CARE PA

Table of content: (NPI 1801819941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801819941 NPI number — RIVERTOWN EYE CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERTOWN EYE CARE PA
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:
1801819941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 N FRONTAGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55033-2662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-437-5469
Provider Business Mailing Address Fax Number:
651-437-2910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 N FRONTAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55033-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-437-5469
Provider Business Practice Location Address Fax Number:
651-437-2910
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLAPNICHER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT/OWNER/CEO
Authorized Official Telephone Number:
651-437-5469

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3C781RI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 96402 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2115746 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 478075200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 442 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 56636SL . 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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