Provider Demographics
NPI:1417036278
Name:MCLEOD OPTICAL
Entity Type:Organization
Organization Name:MCLEOD OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-587-6309
Mailing Address - Street 1:211 FREEMONT AVE SE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3116
Mailing Address - Country:US
Mailing Address - Phone:320-587-6309
Mailing Address - Fax:320-587-5879
Practice Address - Street 1:211 FREEMONT AVE SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3116
Practice Address - Country:US
Practice Address - Phone:320-587-6309
Practice Address - Fax:320-587-5879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0298800001Medicare ID - Type Unspecified