Organization
DOUBLE IMAGE, INC
Active
Other names
Pearle Vision
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANNIE L KELLER (PRESIDENT)
(952) 435-2662
Entity
Organization
Contact information
Practice address
1056 BURNSVILLE CTR, BURNSVILLE, MN 55306-4408
(952) 435-2662
(952) 435-2624
Mailing address
PO BOX 241509, APPLE VALLEY, MN 55124-1509
(952) 435-2662
(952) 435-2624
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120188
MEDICA
MN
01
—
3C310PE
BLUE CROSS BLUE SHIELD MN
MN
Enumeration date
11/07/2006
Last updated
07/31/2007
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