Provider Demographics
NPI:1568516953
Name:HORNER FAMILY EYECARE, INC.
Entity Type:Organization
Organization Name:HORNER FAMILY EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-714-2015
Mailing Address - Street 1:8360 CITY CENTRE DRIVE
Mailing Address - Street 2:#140
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-714-2015
Mailing Address - Fax:651-714-2010
Practice Address - Street 1:8360 CITY CENTRE DRIVE
Practice Address - Street 2:#140
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-714-2015
Practice Address - Fax:651-714-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN108L6H0OtherBLUE CROSS BLUE SHIELD
MN799323400Medicaid
MN93537OtherHEALTH PARTNERS
MN93537OtherHEALTH PARTNERS
MNC03384Medicare ID - Type Unspecified
MN799323400Medicaid