Provider Demographics
NPI:1952577108
Name:NORTH CENTRAL OPHTHALMICS
Entity Type:Organization
Organization Name:NORTH CENTRAL OPHTHALMICS
Other - Org Name:CARL ZEISS VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-255-9787
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:4605 RUSAN ST
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-255-9787
Mailing Address - Fax:320-255-1046
Practice Address - Street 1:4605 RUSAN ST
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-255-9787
Practice Address - Fax:320-255-1046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARL ZEISS VISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38452100Medicaid