Provider Demographics
NPI:1346291630
Name:DOFFIN FAMILY EYE CARE PA
Entity Type:Organization
Organization Name:DOFFIN FAMILY EYE CARE PA
Other - Org Name:WHITE BEAR EYE CLINIC AND OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-429-3379
Mailing Address - Street 1:4750 WASHINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3257
Mailing Address - Country:US
Mailing Address - Phone:651-429-3379
Mailing Address - Fax:651-429-8681
Practice Address - Street 1:4750 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3257
Practice Address - Country:US
Practice Address - Phone:651-429-3379
Practice Address - Fax:651-429-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27679RUOtherBLUE CROSS BLUE SHIELD
MN105474OtherUCARE
MN2200089OtherMEDICA
MN2117748OtherMEDICA-DME
MN29623WHOtherBLUE CROSS BLUE SHIELD
MN307262200Medicaid
MN307262200Medicaid