1821143728 NPI number — HATAYE-SOFTING OPTOMETRISTS, LTD.

Table of content: (NPI 1821143728)

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:
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:
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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