Provider Demographics
NPI:1477780914
Name:CONROY EYE CARE, PA
Entity type:Organization
Organization Name:CONROY EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-289-1810
Mailing Address - Street 1:229 N MILES ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56208-1318
Mailing Address - Country:US
Mailing Address - Phone:320-289-1810
Mailing Address - Fax:
Practice Address - Street 1:229 N MILES ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208-1318
Practice Address - Country:US
Practice Address - Phone:320-289-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4758330002OtherDMERC
MN377725100Medicaid
MN60D65COOtherBCBS
P00048427OtherRAILROAD MC
MN377725100Medicaid