Provider Demographics
NPI:1437233079
Name:EYECARE CENTERS OF AITKIN & MCGREGOR OPTOMETRISTS, PA
Entity Type:Organization
Organization Name:EYECARE CENTERS OF AITKIN & MCGREGOR OPTOMETRISTS, PA
Other - Org Name:EYECARE CENTER OF MCGREGOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-927-3213
Mailing Address - Street 1:241 W. HWY. 210
Mailing Address - Street 2:
Mailing Address - City:MCGREGOR
Mailing Address - State:MN
Mailing Address - Zip Code:55760
Mailing Address - Country:US
Mailing Address - Phone:218-768-7000
Mailing Address - Fax:
Practice Address - Street 1:241 W. HWY. 210
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:MN
Practice Address - Zip Code:55760
Practice Address - Country:US
Practice Address - Phone:218-768-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2588152W00000X
MN1998152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN281815900Medicaid
0403650002Medicare NSC
MN281815900Medicaid