Provider Demographics
NPI:1386861367
Name:MIDWEST EYE LABORATORIES INC
Entity Type:Organization
Organization Name:MIDWEST EYE LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:715-833-2277
Mailing Address - Street 1:4606 COMMERCE VALLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7075
Mailing Address - Country:US
Mailing Address - Phone:715-833-2277
Mailing Address - Fax:715-833-2295
Practice Address - Street 1:4606 COMMERCE VALLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7075
Practice Address - Country:US
Practice Address - Phone:715-833-2277
Practice Address - Fax:715-833-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0943035Medicaid
WI1841416062Medicaid
MN503306300Medicaid
WI38430000Medicaid