Provider Demographics
NPI:1497792758
Name:BIETER EYE CENTER LTD
Entity Type:Organization
Organization Name:BIETER EYE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIETER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-769-1020
Mailing Address - Street 1:8617 W POINT DOUGLAS RD S
Mailing Address - Street 2:#110
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4005
Mailing Address - Country:US
Mailing Address - Phone:651-769-1020
Mailing Address - Fax:651-769-1021
Practice Address - Street 1:8617 W POINT DOUGLAS RD S
Practice Address - Street 2:#110
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4005
Practice Address - Country:US
Practice Address - Phone:651-769-1020
Practice Address - Fax:651-769-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2478152W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5760000001Medicare NSC