Provider Demographics
NPI:1205214236
Name:ASSOCIATED EYE CARE OPTICAL LLC
Entity Type:Organization
Organization Name:ASSOCIATED EYE CARE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCEUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-275-3002
Mailing Address - Street 1:1719 TOWER DR W SUITE 100
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7215
Mailing Address - Country:US
Mailing Address - Phone:651-275-3000
Mailing Address - Fax:651-275-3027
Practice Address - Street 1:411 STAGELINE ROAD SUITE 200
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7848
Practice Address - Country:US
Practice Address - Phone:651-275-3000
Practice Address - Fax:651-275-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier