Provider Demographics
NPI:1164517348
Name:MORRISON EYE CARE OPTOMETRISTS, P.A.
Entity Type:Organization
Organization Name:MORRISON EYE CARE OPTOMETRISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DONAVON
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-847-2020
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-0266
Mailing Address - Country:US
Mailing Address - Phone:218-847-2020
Mailing Address - Fax:218-847-6165
Practice Address - Street 1:1244 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3906
Practice Address - Country:US
Practice Address - Phone:218-847-2020
Practice Address - Fax:218-847-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C962LAOtherBLUE PLUS
MN2229855OtherMEDICA
MN483361046247OtherPREFERRED ONE
MN2129568OtherMEDICA CHOICE
MN2202433OtherMEDICA
MNV501629396OtherHEALTH PARTNERS
MN2202433OtherMEDICA CHOICE
MN483361046248OtherPREFERRED ONE
MN611517900Medicaid
MN61720LAOtherBLUE CROSS BLUE SHIELD
MN4C962LAOtherBLUE PLUS
MNV501629396OtherHEALTH PARTNERS
MN2202433OtherMEDICA
MNT65893Medicare UPIN