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ANNANDALE EYE CLINIC INC NPI 1629148614


NPI Information

NPI: 1629148614
Provider Name: ANNANDALE EYE CLINIC INC

Doing Business As: ANNANDALE EYE CLINIC

Classification: Optometrist - 152W00000X
Entity Type: Organization

CLIA Number: 24D2264422

Address:
500 ELM ST E
ANNANDALE, MN
ZIP 55302
Phone: (320) 274-3701
Get Directions

ANNANDALE EYE CLINIC INC is an optometrist in Annandale, MN. The provider is doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. ANNANDALE EYE CLINIC INC NPI is 1629148614. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Annandale Eye Clinic.

The provider's business location address is:

500 ELM ST E
ANNANDALE, MN
ZIP 55302
Phone: (320) 274-3701
Fax: (320) 274-3784

The provider's authorized official is Terrence Lee Tancabel .
The authorized official title is Owner and has the following contact phone number (320) 274-3701.

The CLIA number assigned to this NPI record is 24D2264422 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/8/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152W00000XOptometrist1765MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1230R3TAOTHERMINNESOTABCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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