Healthcare Provider Details

I. General information

NPI: 1073682191
Provider Name (Legal Business Name): MIDWEST VISION CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 ATLANTIC AVE
MORRIS MN
56267
US

IV. Provider business mailing address

PO BOX 456
ST. CLOUD MN
56302
US

V. Phone/Fax

Practice location:
  • Phone: 320-589-1300
  • Fax: 320-589-3348
Mailing address:
  • Phone: 320-252-5777
  • Fax: 320-258-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: CARIN M EVANS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 320-252-5777