Provider Demographics
NPI:1518950708
Name:BLUE EARTH VALLEY EYE CLINIC LTD
Entity Type:Organization
Organization Name:BLUE EARTH VALLEY EYE CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-526-2222
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-0036
Mailing Address - Country:US
Mailing Address - Phone:507-526-2222
Mailing Address - Fax:507-526-3927
Practice Address - Street 1:435 S GROVE ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-2604
Practice Address - Country:US
Practice Address - Phone:507-526-2222
Practice Address - Fax:507-526-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center