1386679033 NPI number — MORRISON EYE CARE OPTOMETRISTS, P.A.

Table of content: (NPI 1386679033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386679033 NPI number — MORRISON EYE CARE OPTOMETRISTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRISON EYE CARE OPTOMETRISTS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386679033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAHNOMEN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56557-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-936-2020
Provider Business Mailing Address Fax Number:
218-936-5541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
785 SOUTH HIGHWAY 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAHNOMEN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56557-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-936-2020
Provider Business Practice Location Address Fax Number:
218-936-5541
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRISON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
218-847-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1739 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2977 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 204216900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63568MO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 410036752 . This is a "PALMETTO GBA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C547LA . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 121200 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 23955 . This is a "AVESIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 51922 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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