Provider Demographics
NPI:1669664835
Name:APPLE VALLEY EYE CARE P.A.
Entity Type:Organization
Organization Name:APPLE VALLEY EYE CARE P.A.
Other - Org Name:APPLE VALLEY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-432-0680
Mailing Address - Street 1:7789 147TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7552
Mailing Address - Country:US
Mailing Address - Phone:952-432-0680
Mailing Address - Fax:952-432-8823
Practice Address - Street 1:7789 147TH ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:952-432-0680
Practice Address - Fax:952-432-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0672060001Medicare NSC
MNC03538Medicare PIN