Provider Demographics
NPI:1497817928
Name:LYNETTE ROSE CATAPANO OD PC
Entity Type:Organization
Organization Name:LYNETTE ROSE CATAPANO OD PC
Other - Org Name:CLEARVIEW EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CATAPANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PC
Authorized Official - Phone:320-558-9403
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55320-0275
Mailing Address - Country:US
Mailing Address - Phone:320-558-9403
Mailing Address - Fax:320-558-4583
Practice Address - Street 1:814 CLEARWATER CTR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:MN
Practice Address - Zip Code:55320
Practice Address - Country:US
Practice Address - Phone:320-558-9403
Practice Address - Fax:320-558-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2281152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN08975OtherSPECTERA
MN65846OtherHEALTH PARTNERS
MN2211986OtherMEDICA
MN73D82CLOtherBLUE CROSS BLUE SHIELD
MN118493OtherEYEMED
MN73D83VROtherBLUE CROSS BLUE SHIELD
MN0730002OtherPREFERRED ONE
MN1309020001OtherMEDICARE SUPPLIER
MN9821216OtherMEDICA
MN2121216OtherMEDICA
MN410048698OtherRAILROAD MEDICARE
MN682225800Medicaid
MN75D85CLOtherBLUE CROSS BLUE SHIELD
MN118493OtherEYEMED
MN682225800Medicaid
MN2211986OtherMEDICA