Provider Demographics
NPI:1669407664
Name:PRECISION VISION INC
Entity type:Organization
Organization Name:PRECISION VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:651-646-8889
Mailing Address - Street 1:1560 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3908
Mailing Address - Country:US
Mailing Address - Phone:651-646-8889
Mailing Address - Fax:651-646-3761
Practice Address - Street 1:1560 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3908
Practice Address - Country:US
Practice Address - Phone:651-646-8889
Practice Address - Fax:651-646-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN102436OtherUCARE
MN2115792OtherMEDICA CHOICE
26981PEOtherBCBS
MN9175OtherHEALTH PARTNERS
MN685762100Medicaid
0324800001Medicare ID - Type Unspecified