Provider Demographics
NPI:1043384803
Name:MIDWEST VISION CENTERS INC
Entity Type:Organization
Organization Name:MIDWEST VISION CENTERS INC
Other - Org Name:TAFT OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-466-5777
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-0456
Mailing Address - Country:US
Mailing Address - Phone:888-466-5777
Mailing Address - Fax:320-258-3136
Practice Address - Street 1:203 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3765
Practice Address - Country:US
Practice Address - Phone:507-537-1976
Practice Address - Fax:507-537-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN121629OtherHEALTH PARTNERS
MN351132000Medicaid
MN2100459OtherMEDICA
MN490P4TAOtherBLUE CROSS BLUE SHIELD
MN112970OtherUCARE
MN23180OtherPREFERRED ONE
MN490P4TAOtherBLUE CROSS BLUE SHIELD