Healthcare Provider Details

I. General information

NPI: 1497792758
Provider Name (Legal Business Name): PREMIER EYE CARE, COTTAGE GROVE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6936 PINE ARBOR DR S STE 110
COTTAGE GROVE MN
55016-4672
US

IV. Provider business mailing address

8617 W POINT DOUGLAS RD S #110
COTTAGE GROVE MN
55016-4005
US

V. Phone/Fax

Practice location:
  • Phone: 651-769-1020
  • Fax: 651-769-1021
Mailing address:
  • Phone: 651-769-1020
  • Fax: 651-769-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2478
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY M BIETER
Title or Position: PRESIDENT
Credential: OD
Phone: 651-769-1020