Provider Demographics
NPI:1811452048
Name:LITTLE FALLS EYE CARE CENTER PA
Entity type:Organization
Organization Name:LITTLE FALLS EYE CARE CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HINDERSCHIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-3676
Mailing Address - Street 1:2306 S. BROADWAY STR. SUITE 12
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-763-7782
Mailing Address - Fax:320-763-0504
Practice Address - Street 1:2306 S. BROADWAY STR. SUITE 12
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-763-7782
Practice Address - Fax:320-763-0504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE FALLS EYE CARE CENTER P.A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-01
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty