Provider Demographics
NPI:1609897594
Name:LITTLE FALLS EYE CARE CENTER P.A
Entity Type:Organization
Organization Name:LITTLE FALLS EYE CARE CENTER P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HINDERSCHIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-3676
Mailing Address - Street 1:313 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3005
Mailing Address - Country:US
Mailing Address - Phone:320-632-3676
Mailing Address - Fax:320-632-3677
Practice Address - Street 1:313 1ST ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3005
Practice Address - Country:US
Practice Address - Phone:320-632-3676
Practice Address - Fax:320-632-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN167238E979OtherUCARE
MN21-16068OtherMEDICA
MN586062800Medicaid
MN1099200001OtherADMINISTAR DMERC
MN41074OtherHEALTH PARTNERS
FM4C998LIOtherBCBS EYEGLASSES
MNDC1861OtherRAILROAD MEDICARE
MN0005852588OtherAETNA
MN01006331OtherPREFERRED ONE
MN4C929LIOtherBLUE CROSS BLUE SHIELD
MN167238E979OtherUCARE