Organization
MINNESOTA VISION GROUP PA
Active
Organization
MINNESOTA VISION GROUP PA
Active
Other names
Insight Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BURT W DUBOW O.D. (OWNER)
(320) 253-0365
Entity
Organization
Contact information
Practice address
206 W DIVISION ST, WAITE PARK, MN 56387-1331
(320) 253-0365
(320) 253-9401
Mailing address
PO BOX 7654, SAINT CLOUD, MN 56302-7654
(320) 253-0365
(320) 253-9401
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0464710001
NATIONAL SUPPLIER CLEARINGHOUSE
—
05
—
161524600
—
MN
01
—
4C750MI
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/19/2006
Last updated
10/09/2012
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