Provider Demographics
NPI:1376709097
Name:HAWKEYE CLINIC OF HUTCHINSON II, P.C.
Entity Type:Organization
Organization Name:HAWKEYE CLINIC OF HUTCHINSON II, P.C.
Other - Org Name:CROW RIVER EYE CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-587-2593
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:225 MAIN ST S.
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2508
Mailing Address - Country:US
Mailing Address - Phone:320-587-2593
Mailing Address - Fax:320-587-5852
Practice Address - Street 1:225 MAIN ST S.
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2508
Practice Address - Country:US
Practice Address - Phone:320-587-2593
Practice Address - Fax:320-587-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
22-01141OtherMEDICA
MN692690800Medicaid
90332OtherHEALTH PARTNERS
342J8CROtherBCBS
774461025292OtherPREFERRED ONE
040506009OtherPRIMEWEST
2775OtherUNICARE
342J7CROtherBLUE PLUS MATERIALS
410046161OtherRAILROAD MEDICARE
H379OtherUCARE
342J7CROtherBLUE PLUS MATERIALS
H379OtherUCARE
410001964Medicare PIN