Provider Demographics
NPI:1386679033
Name:MORRISON EYE CARE OPTOMETRISTS, P.A.
Entity Type:Organization
Organization Name:MORRISON EYE CARE OPTOMETRISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DONAVON
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-936-2020
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:MAHNOMEN
Mailing Address - State:MN
Mailing Address - Zip Code:56557-0339
Mailing Address - Country:US
Mailing Address - Phone:218-936-2020
Mailing Address - Fax:218-936-5541
Practice Address - Street 1:785 SOUTH HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557-5007
Practice Address - Country:US
Practice Address - Phone:218-936-2020
Practice Address - Fax:218-936-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1739152W00000X
MN2977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51922OtherHEALTH PARTNERS
MN63568MOOtherBCBS
MN410036752OtherPALMETTO GBA
MN23955OtherAVESIS
MN121200OtherUCARE
MN204216900Medicaid
MN4C547LAOtherBLUE PLUS
MN410036752OtherPALMETTO GBA
MN204216900Medicaid