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Organization
EYE Q OPTOMETRIC CLINIC, LIMITED
Active
Organization
EYE Q OPTOMETRIC CLINIC, LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARWIN DALEN (OWNER)
(218) 326-9619
Entity
Organization
Contact information
Practice address
201 NW 4TH ST, SUITE 107, GRAND RAPIDS, MN 55744-2753
(218) 326-9619
Mailing address
201 NW 4TH ST, SUITE 107, GRAND RAPIDS, MN 55744-2753
(218) 326-9619
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
2529
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245428135
RAILROAD MEDICARE
MN
01
—
5C956EY
BLUE CROSS BLUE SHIELD
MN
01
—
C04933
RAILROAD MEDICARE PTAN
MN
01
—
U58324
RAILROAD MEDICARE
MN
Enumeration date
10/04/2007
Last updated
05/24/2016
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