Provider Demographics
NPI:1689600900
Name:FAMILY EYE CLINIC & CONTACT LENS CENTER
Entity Type:Organization
Organization Name:FAMILY EYE CLINIC & CONTACT LENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-934-6926
Mailing Address - Street 1:3822 WEST OLD SHAKOPEE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3538
Mailing Address - Country:US
Mailing Address - Phone:952-884-4366
Mailing Address - Fax:952-884-4809
Practice Address - Street 1:3822 WEST OLD SHAKOPEE ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3538
Practice Address - Country:US
Practice Address - Phone:952-884-4366
Practice Address - Fax:952-884-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C791FAOtherBLUE CROSS BLUE SHIELD
MNCF8810OtherRAIL ROAD MEDICARE
MN3687422-00Medicaid
MN01012099OtherPREFERRED ONE