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General NPI Number Information
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NPI Number | 1144364894
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Entity Type | Organization
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Legal Business Name | MIDWEST VISION CENTERS INC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 830 WASHINGTON AVENUE
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City | DETROIT LAKES
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State | MN
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Zip | 56501
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Country | US
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Telephone | 218-847-2127
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Fax | 218-847-0911
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Provider Business Mailing Address
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Address Line | PO BOX 456
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City | SAINT CLOUD
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State | MN
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Zip | 56302
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Country | US
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Telephone | 320-252-5777
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Fax | 320-258-3136
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | CARIN MARIE EVANS
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Credential |
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Telephone | 320-252-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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