Provider Demographics
NPI:1093027526
Name:GAVIN EYE CONSULTING PLLC
Entity type:Organization
Organization Name:GAVIN EYE CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-458-3118
Mailing Address - Street 1:23886 STATE HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7546
Mailing Address - Country:US
Mailing Address - Phone:507-995-9747
Mailing Address - Fax:763-444-3996
Practice Address - Street 1:115 DREW AVE SE
Practice Address - Street 2:SUITE 201
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1873
Practice Address - Country:US
Practice Address - Phone:507-995-9747
Practice Address - Fax:763-444-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35388207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN189000187Medicare PIN