Provider Demographics
NPI:1801129705
Name:MIDWEST VISION CENTERS, INC.
Entity type:Organization
Organization Name:MIDWEST VISION CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-252-5777
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-0456
Mailing Address - Country:US
Mailing Address - Phone:320-252-5777
Mailing Address - Fax:320-258-3762
Practice Address - Street 1:2800 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6076
Practice Address - Country:US
Practice Address - Phone:701-757-4100
Practice Address - Fax:701-757-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60680Medicaid
ND4868460030Medicare NSC
NDN711326Medicare PIN