Provider Demographics
NPI:1174838098
Name:MIDWEST EYE LABORATORIES SIOUX FALLS LLC
Entity Type:Organization
Organization Name:MIDWEST EYE LABORATORIES SIOUX FALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OCULARIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:715-831-9000
Mailing Address - Street 1:800 WISCONSIN ST.
Mailing Address - Street 2:MAILBOX 103
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3613
Mailing Address - Country:US
Mailing Address - Phone:715-831-9000
Mailing Address - Fax:715-831-9090
Practice Address - Street 1:1600 S WESTERN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1315
Practice Address - Country:US
Practice Address - Phone:715-831-9000
Practice Address - Fax:715-831-9090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISE OCULAR PROSTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-16
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38459900Medicaid
MN1174838098Medicaid
6451710001Medicare NSC