Provider Demographics
NPI:1245303825
Name:COKATO EYE CENTER, INC.
Entity type:Organization
Organization Name:COKATO EYE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT LEAD
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-286-5695
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:115 OLSEN BLVD
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321
Mailing Address - Country:US
Mailing Address - Phone:320-286-5695
Mailing Address - Fax:320-286-5742
Practice Address - Street 1:115 OLSEN BLVD
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321
Practice Address - Country:US
Practice Address - Phone:320-286-5695
Practice Address - Fax:320-286-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN432724100Medicaid
MN1195230001Medicare NSC
30338Medicare UPIN