Provider Demographics
NPI:1235151291
Name:MINNESOTA VISION GROUP PA
Entity Type:Organization
Organization Name:MINNESOTA VISION GROUP PA
Other - Org Name:INSIGHT EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDERICHS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-253-0365
Mailing Address - Street 1:206 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1331
Mailing Address - Country:US
Mailing Address - Phone:320-253-0365
Mailing Address - Fax:320-253-9401
Practice Address - Street 1:206 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1662
Practice Address - Country:US
Practice Address - Phone:320-253-0365
Practice Address - Fax:320-253-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN161524600Medicaid
MN2298740OtherMEDICA
MN54327CLOtherBCBS
MN2352OtherHEALTH PARTNERS
MNDB8950Medicare PIN
MN161524600Medicaid
MN54327CLOtherBCBS
MN2352OtherHEALTH PARTNERS