Organization
FAMILY EYE CLINIC & CONTACT LENS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA REESE (BILLER)
(952) 934-6926
Entity
Organization
Contact information
Practice address
3822 WEST OLD SHAKOPEE ROAD, BLOOMINGTON, MN 55431-3538
(952) 884-4366
(952) 884-4809
Mailing address
3822 WEST OLD SHAKOPEE RD, BLOOMINGTON, MN 55431-3538
(952) 884-4366
(952) 884-4809
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01012099
PREFERRED ONE
MN
05
—
3687422-00
—
MN
01
—
4C791FA
BLUE CROSS BLUE SHIELD
MN
01
—
CF8810
RAIL ROAD MEDICARE
MN
Enumeration date
06/26/2006
Last updated
07/01/2024
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