Healthcare Provider Details

I. General information

NPI: 1306918024
Provider Name (Legal Business Name): MIDWEST VISION CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 LABREE AVE N
THIEF RIVER FALLS MN
56701-2034
US

IV. Provider business mailing address

PO BOX 456
SAINT CLOUD MN
56302-0456
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-5606
  • Fax: 218-681-5609
Mailing address:
  • Phone: 888-466-5777
  • Fax: 320-258-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARIN MARIE EVANS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 888-466-5777