Provider Demographics
NPI:1477720795
Name:CONROY EYE CARE PC
Entity Type:Organization
Organization Name:CONROY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-563-4610
Mailing Address - Street 1:1011 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1303
Mailing Address - Country:US
Mailing Address - Phone:320-563-4610
Mailing Address - Fax:320-563-4657
Practice Address - Street 1:1011 BROADWAY
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1303
Practice Address - Country:US
Practice Address - Phone:320-563-4610
Practice Address - Fax:320-563-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4645120001OtherDMERC
MN358723100Medicaid
MC0076150OtherDEA
MNC05125Medicare PIN
MN4645120001OtherDMERC
MN4645120001Medicare NSC