Provider Demographics
NPI:1912332271
Name:TEC LLC
Entity Type:Organization
Organization Name:TEC LLC
Other - Org Name:TOTAL EYE CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-257-8421
Mailing Address - Street 1:11725 STINSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9542
Mailing Address - Country:US
Mailing Address - Phone:651-257-8421
Mailing Address - Fax:651-257-8464
Practice Address - Street 1:10961 CLUB WEST PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5866
Practice Address - Country:US
Practice Address - Phone:763-571-7550
Practice Address - Fax:763-253-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0193332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4602400002OtherMEDICARE DME
MN827983700Medicaid