=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609897594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE FALLS EYE CARE CENTER P.A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 02/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 1ST ST SE
-----------------------------------------------------
City | LITTLE FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56345-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-632-3676
-----------------------------------------------------
Fax | 320-632-3677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 1ST ST SE
-----------------------------------------------------
City | LITTLE FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56345-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-632-3676
-----------------------------------------------------
Fax | 320-632-3677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | TIM ROBERT HINDERSCHIED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 320-632-3676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------