Healthcare Provider Details

I. General information

NPI: 1346343423
Provider Name (Legal Business Name): MIDWEST VISION CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 QUAIL ROAD NE
SAUK RAPIDS MN
56379
US

IV. Provider business mailing address

PO BOX 456
ST CLOUD MN
56302
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: LARRY LEE PEARSON
Title or Position: V PRES
Credential:
Phone: 320-252-5777