Provider Demographics
NPI:1144364894
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
Mailing Address - Country:US
Mailing Address - Phone:320-252-5777
Mailing Address - Fax:320-258-3136
Practice Address - Street 1:830 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501
Practice Address - Country:US
Practice Address - Phone:218-847-2127
Practice Address - Fax:218-847-0911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST VISION CENTERS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMN1917OtherEYEMED PROVIDER NUMBER
MN04S34STOtherBCBS MINNESOTA
ND890422OtherNORTH DAKOTA VISION SERVI
MN125785400Medicaid
MN21-12067OtherMEDICA PROVIDER ID DISPEN
MN24G89STOtherBCBS MN EXAMS
MN22-00802OtherMEDICA PROVIDER ID EXAMS
MN4235360001Medicare NSC