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NPI Code Detail

MEDICARE: HOMETOWN EYE CARE, INC

MEDICARE: HOMETOWN EYE CARE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841221785
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOMETOWN EYE CARE, INC
Provider Business Mailing Address
First Line : 621 ROSE DR
Second Line :
City : BIG LAKE
State : MN
Zip : 55309-4653
Country : US
Telephone Number : 763-263-8444
Fax Number : 763-263-8583
Provider Business Practice Location Address
First Line : 621 ROSE DR
Second Line :
City : BIG LAKE
State : MN
Zip : 55309-4653
Country : US
Telephone Number : 763-263-8444
Fax Number : 763-263-8583
Authorized Official
Title or Position : PRESIDENT
Name : JENNIE J SEALOCK
Credential :
Telephone Number : 763-263-8444
Provider Enumeration Date : 07/06/2006
Last Update Date : 10/13/2008

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Directions to “HOMETOWN EYE CARE, INC ” Practice Location

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