Provider Demographics
NPI:1922010529
Name:MIDWEST OPTICAL & CONTACT LENS CENTER LLC
Entity Type:Organization
Organization Name:MIDWEST OPTICAL & CONTACT LENS CENTER LLC
Other - Org Name:VISTA EYES & CONTACT LENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUJAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-969-3290
Mailing Address - Street 1:990 W 41ST ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3045
Mailing Address - Country:US
Mailing Address - Phone:218-263-8956
Mailing Address - Fax:218-263-8494
Practice Address - Street 1:990 W 41ST ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3045
Practice Address - Country:US
Practice Address - Phone:218-263-8956
Practice Address - Fax:218-263-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4653420001Medicare NSC