Provider Demographics
NPI:1336448034
Name:IFE - MN, INC
Entity Type:Organization
Organization Name:IFE - MN, INC
Other - Org Name:ALBERTVILLE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:612-388-2637
Mailing Address - Street 1:5585 LA CENTRE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4687
Mailing Address - Country:US
Mailing Address - Phone:763-497-2115
Mailing Address - Fax:
Practice Address - Street 1:5585 LA CENTRE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4687
Practice Address - Country:US
Practice Address - Phone:763-497-2115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05861Medicare PIN