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:651-739-4111
Mailing Address - Street 1:7582 CURRELL BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8212
Mailing Address - Country:US
Mailing Address - Phone:651-739-4111
Mailing Address - Fax:651-412-5069
Practice Address - Street 1:4921 E 26TH ST STE 2
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-6965
Practice Address - Country:US
Practice Address - Phone:605-332-7052
Practice Address - Fax:651-412-5069
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:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1174838098Medicaid
WI38459900Medicaid
6451710001Medicare NSC