Healthcare Provider Details

I. General information

NPI: 1801129705
Provider Name (Legal Business Name): MIDWEST VISION CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S COLUMBIA RD
GRAND FORKS ND
58201-6076
US

IV. Provider business mailing address

PO BOX 456
SAINT CLOUD MN
56302-0456
US

V. Phone/Fax

Practice location:
  • Phone: 701-757-4100
  • Fax: 701-757-4101
Mailing address:
  • Phone: 320-252-5777
  • Fax: 320-258-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

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