Provider Demographics
NPI:1235152224
Name:KASSON EYE CARE PA
Entity Type:Organization
Organization Name:KASSON EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LESKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-634-4445
Mailing Address - Street 1:504 S MANTORVILLE AVENUE
Mailing Address - Street 2:STE 1
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-2207
Mailing Address - Country:US
Mailing Address - Phone:507-634-4445
Mailing Address - Fax:507-634-7940
Practice Address - Street 1:504 S MANTORVILLE AVENUE
Practice Address - Street 2:STE 1
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-2207
Practice Address - Country:US
Practice Address - Phone:507-634-4445
Practice Address - Fax:507-634-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22838OtherMEDICA
MN122237OtherUCARE
MN96969OtherPREFERRED ONE
MN5C123KAOtherBLUE PLUS
MN63203KAOtherBLUE CROSS & BLUE SHIELD
MN4310280001Medicare NSC
MNC02778Medicare PIN