Provider Demographics
NPI:1326235912
Name:ASSOCIATE OPTOMETRY, P.A.
Entity Type:Organization
Organization Name:ASSOCIATE OPTOMETRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-526-2020
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-0309
Mailing Address - Country:US
Mailing Address - Phone:507-526-2020
Mailing Address - Fax:507-526-4421
Practice Address - Street 1:111 E 6TH ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-2003
Practice Address - Country:US
Practice Address - Phone:507-526-2020
Practice Address - Fax:507-526-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO2240Medicare Oscar/Certification