Provider Demographics
NPI:1225127756
Name:HUTCHINSON SUPERSTORE INC
Entity Type:Organization
Organization Name:HUTCHINSON SUPERSTORE INC
Other - Org Name:PRIMARY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-587-4744
Mailing Address - Street 1:1059 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1059 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3153
Practice Address - Country:US
Practice Address - Phone:320-587-4744
Practice Address - Fax:320-587-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
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MN737262100Medicaid
MN030701096OtherPRIME WEST
MN115398OtherU-CARE
MN47807DUOtherBCBS EXAMS
MN2128810OtherMEDICA
MN47808DUOtherBCBS EYEWEAR
8343959OtherAETNA
MNHP29396OtherHEALTH PARTNERS
MN2128810OtherMEDICA
MN0226660001Medicare NSC