Provider Demographics
NPI:1477624252
Name:DOUBLE IMAGE, INC
Entity Type:Organization
Organization Name:DOUBLE IMAGE, INC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-435-2662
Mailing Address - Street 1:PO BOX 241509
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-1509
Mailing Address - Country:US
Mailing Address - Phone:952-435-2662
Mailing Address - Fax:952-435-2624
Practice Address - Street 1:3001 WHITE BEAR AVE N
Practice Address - Street 2:SUITE 1050
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-1215
Practice Address - Country:US
Practice Address - Phone:651-770-3923
Practice Address - Fax:651-770-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C314PEOtherBLUE CROSS BLUE SHIELD MN
MN2120179OtherMEDICA
MN3C314PEOtherBLUE CROSS BLUE SHIELD MN