Provider Demographics
NPI:1821143728
Name:HATAYE-SOFTING OPTOMETRISTS, LTD.
Entity Type:Organization
Organization Name:HATAYE-SOFTING OPTOMETRISTS, LTD.
Other - Org Name:INNOVISION EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HATAYE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-373-0627
Mailing Address - Street 1:232 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2521
Mailing Address - Country:US
Mailing Address - Phone:507-373-0627
Mailing Address - Fax:507-373-0628
Practice Address - Street 1:232 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2521
Practice Address - Country:US
Practice Address - Phone:507-373-0627
Practice Address - Fax:507-373-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2189152W00000X
MN2212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2200450OtherMEDICA
MN409523500Medicaid
MN4C068SOOtherBCBSM ALAINA
MN122609OtherUCARE ALAINA
MN1011298OtherPREFERRED ONE ALAINA
MN115713OtherUCARE GARETH
MN169323900Medicaid
MN1011297OtherPREFERRED ONE GARETH
MN4C070PAOtherBCBSM OPTICAL
MN2200104OtherMEDICA OPTICAL
MN4C067PAOtherBCBSM GROUP
MN123247OtherUCARE GROUP
MN4C069HAOtherBCBSM GARETH
MNU02805Medicare UPIN
MN4C069HAOtherBCBSM GARETH
MN123247OtherUCARE GROUP
MN419000275Medicare ID - Type UnspecifiedPART B GARETH
MN169323900Medicaid
MN4C070PAOtherBCBSM OPTICAL
MN410038753Medicare ID - Type UnspecifiedRAILROAD MEDICARE ALAINA