Organization
ANNANDALE EYE CLINIC INC
Active
Other names
Annandale Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRENCE LEE TANCABEL O.D. (OWNER)
(320) 274-3701
Entity
Organization
Contact information
Practice address
500 ELM ST E, ANNANDALE, MN 55302
(320) 274-3701
(320) 274-3784
Mailing address
PO BOX 128, ANNANDALE, MN 55302-0128
(320) 274-3701
(320) 274-3784
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1765
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230R3TA
BCBS
MN
Enumeration date
11/08/2006
Last updated
08/22/2020
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