Provider Demographics
NPI:1134274475
Name:ST. PETER EYECARE CENTER
Entity type:Organization
Organization Name:ST. PETER EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-931-6436
Mailing Address - Street 1:320 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1352
Mailing Address - Country:US
Mailing Address - Phone:507-931-6436
Mailing Address - Fax:507-934-9625
Practice Address - Street 1:320 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1352
Practice Address - Country:US
Practice Address - Phone:507-931-6436
Practice Address - Fax:507-934-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0322460001OtherDMERC
MN0582866OtherIOWA MEDICAID
MN15568OtherHEALTHPARTNERS
MN22-12052OtherMEDICA
MN33077DIOtherBLUE CROSSBLUE SHIELD
MN114338OtherUCARE
MN2216066OtherMEDICA EYEWEAR/CARE
MN44977THOtherBLUEPLUS EYEWEAR
MN98698OtherPREFERRED ONE
MNCK5179OtherMEDICARE RAILROAD
MN0322460001OtherDMERC
MN33077DIOtherBLUE CROSSBLUE SHIELD