Provider Demographics
NPI:1740309640
Name:CRYSTAL VIEW EYE CARE
Entity type:Organization
Organization Name:CRYSTAL VIEW EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER--OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SWEZEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-726-6639
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:102 W HUMPHREY ST
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-0158
Mailing Address - Country:US
Mailing Address - Phone:507-726-6639
Mailing Address - Fax:507-726-6382
Practice Address - Street 1:102 W HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL,
Practice Address - State:MN
Practice Address - Zip Code:56055-0158
Practice Address - Country:US
Practice Address - Phone:507-726-6639
Practice Address - Fax:507-726-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2215152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114270OtherUCARE CLINIC ID#
MN22-20126OtherMEDICA ID#
MN35770CROtherBCBS OF MN CLINIC ID#
MN248078600Medicaid
MN38204OtherHEALTH PARTNERS OFFICE ID
MN280025000Medicaid
MN4C995CROtherBCBS OF MN ID# (PRODUCT)
MN4C995CROtherBCBS OF MN ID# (PRODUCT)