Provider Demographics
NPI:1164861357
Name:OPTOMETRIC EYE CARE CENTERS, PA
Entity Type:Organization
Organization Name:OPTOMETRIC EYE CARE CENTERS, PA
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALBERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-574-0075
Mailing Address - Street 1:1202 MOORE LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5170
Mailing Address - Country:US
Mailing Address - Phone:763-574-0075
Mailing Address - Fax:763-574-0594
Practice Address - Street 1:7880 MAIN ST N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7081
Practice Address - Country:US
Practice Address - Phone:763-420-6981
Practice Address - Fax:763-773-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty