Provider Demographics
NPI:1497859813
Name:OPTOMETRY 2000 VISION CARE, INC
Entity Type:Organization
Organization Name:OPTOMETRY 2000 VISION CARE, INC
Other - Org Name:MELROSE EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GROETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-256-4000
Mailing Address - Street 1:203 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1485
Mailing Address - Country:US
Mailing Address - Phone:320-256-4000
Mailing Address - Fax:320-256-4002
Practice Address - Street 1:203 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1485
Practice Address - Country:US
Practice Address - Phone:320-256-4000
Practice Address - Fax:320-256-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410049128OtherRAILROAD MEDICARE PROV. N
MNMN2082OtherEYEMED PROVIDER NUMBER
MN380225600Medicaid
MN21-00019OtherMEDICA GLASSES PROV. NUMB
MN115186OtherUCARE GLASSES PROVIDER NU
MN5C705GROtherBCBS GLASSES PROV. NUMBER
MN21-00019OtherMEDICA GLASSES PROV. NUMB