Organization
MOOSE LAKE EYE CARE, LLC
Active
Parent organization
MOOSE LAKE EYE CARE, LLC D/B/A NORTHERN MINNESOTA EYE CARE
Other names
Northern Minnesota Eye Care, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOOSE LAKE EYE CARE, LLC D/B/A NORTHERN MINNESOTA EYE CARE
Authorized official
SASHA N NARAYAN O.D. (PRESIDENT)
(218) 485-8495
Entity
Organization
Contact information
Practice address
45 LADY LUCK DR., SUITE 120, HINCKLEY, MN 55037
(320) 384-6361
(320) 384-6361
Mailing address
PO BOX 728, HINCKLEY, MN 55037-0728
(320) 384-6361
(320) 384-6361
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
152W00000X
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235188079
PROVIDER NPI
MN
01
—
1275582421
PROVIDER NPI
MN
05
—
1411674742
—
MN
01
—
1760558399
PROVIDER NPI
MN
Enumeration date
04/27/2015
Last updated
04/27/2015
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