Provider Demographics
NPI:1245384668
Name:HATAYE-SOFTING OPTOMETRISTS, LTD.
Entity Type:Organization
Organization Name:HATAYE-SOFTING OPTOMETRISTS, LTD.
Other - Org Name:INNOVISION EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HATAYE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-437-7768
Mailing Address - Street 1:318 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3406
Mailing Address - Country:US
Mailing Address - Phone:507-437-7768
Mailing Address - Fax:507-437-7769
Practice Address - Street 1:318 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3406
Practice Address - Country:US
Practice Address - Phone:507-437-7768
Practice Address - Fax:507-437-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2189152W00000X
MN2212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C069HAOtherBCBSM GARETH
MN1011297OtherPREFERRED ONE GARETH
MN2200447OtherMEDICA
MN2200104OtherMEDICA OPTICAL
MN123247OtherUCARE GROUP
MN4C067PAOtherBCBSM GROUP
MN4C070PAOtherBCBSM OPTICAL
MN4C068SOOtherBCBSM ALAINA
MN409523500Medicaid
MN1011298OtherPREFERRED ONE ALAINA
MN115713OtherUCARE GARETH
MN122609OtherUCARE ALAINA
MN169323900Medicaid
MN2200104OtherMEDICA OPTICAL
MN2200447OtherMEDICA
MN0914860001Medicare NSC
MN123247OtherUCARE GROUP
MNU02805Medicare UPIN
MN419000274Medicare ID - Type UnspecifiedPART B ALAINA
MN410030370Medicare ID - Type UnspecifiedRAILROAD MEDICARE ALAINA