Provider Demographics
NPI:1578753695
Name:MESABI EYEWEAR, INC.
Entity Type:Organization
Organization Name:MESABI EYEWEAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:AUBOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-749-2448
Mailing Address - Street 1:104 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2519
Mailing Address - Country:US
Mailing Address - Phone:218-749-2448
Mailing Address - Fax:218-749-2448
Practice Address - Street 1:104 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2519
Practice Address - Country:US
Practice Address - Phone:218-749-2448
Practice Address - Fax:218-749-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C819MEOtherFIRST PLAN OF MINNESOTA/B
MN1074070001OtherUNICARE
MN115136OtherUCARE
MN21-14110OtherMEDICA
MN212225100Medicaid
MN1074070001OtherUNICARE