Provider Demographics
NPI:1679623862
Name:SOUTHWEST EYE CARE INC
Entity Type:Organization
Organization Name:SOUTHWEST EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-466-3937
Mailing Address - Street 1:1200 CHASKA CREEK WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2525
Mailing Address - Country:US
Mailing Address - Phone:952-466-3937
Mailing Address - Fax:952-466-3936
Practice Address - Street 1:1200 CHASKA CREEK WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2525
Practice Address - Country:US
Practice Address - Phone:952-466-3937
Practice Address - Fax:952-466-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 156FX1800X
MN51388207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1770631889OtherNPI CHRISTOPHER FREED
MN1801092960OtherNPI
MN1881741213OtherNPI AMY FREED
MN1487644969OtherNPI SCOTT GLASER
MN1033193198OtherNPI PATTY JILEK
MN1104975762OtherNPI CHAD DOCKTER
MN1427052323OtherNPI BERNIE ROTTACH
MN5847980002Medicare NSC
MNU46998Medicare UPIN
MN1033193198OtherNPI PATTY JILEK
MN1770631889OtherNPI CHRISTOPHER FREED
MNU68764Medicare UPIN