Organization
GERRY'S VISION SHOPPE, INC
Active
Other names
Gerry's Vision Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI LYNN KLOCKMANN (PRESIDENT)
(320) 864-6111
Entity
Organization
Contact information
Practice address
1234 GREELEY AVE N, GLENCOE, MN 55336-2103
(320) 864-6111
(320) 864-6134
Mailing address
1234 GREELEY AVE N, PO BOX 186, GLENCOE, MN 55336-2103
(320) 864-6111
(320) 864-6134
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16062GE
BCBS
—
01
—
21-18815
MEDICA
—
01
—
964661001450
PREFERRED ONE
—
Enumeration date
07/12/2005
Last updated
09/11/2025
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