Provider Demographics
NPI:1457438533
Name:LITCHFIELD EYE CLINIC LLC
Entity type:Organization
Organization Name:LITCHFIELD EYE CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:VAN SLOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-214-5754
Mailing Address - Street 1:715 N SIBLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-1765
Mailing Address - Country:US
Mailing Address - Phone:320-693-3100
Mailing Address - Fax:
Practice Address - Street 1:715 N SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-1765
Practice Address - Country:US
Practice Address - Phone:320-693-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5545930152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty