Provider Demographics
NPI:1346343423
Name:MIDWEST VISION CENTERS INC
Entity Type:Organization
Organization Name:MIDWEST VISION CENTERS INC
Other - Org Name:MIDWEST VISION CENTERS TAFT OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V PRES
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-252-5777
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302
Mailing Address - Country:US
Mailing Address - Phone:320-252-5777
Mailing Address - Fax:320-258-3136
Practice Address - Street 1:2767 QUAIL ROAD NE
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379
Practice Address - Country:US
Practice Address - Phone:320-252-5777
Practice Address - Fax:320-258-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier