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Organization

ST PETER EYECARE CENTER, INC

Active
Parent organization
ST PETER EYECARE CENTER, INC
Other names
LeCenter Eyecare
Organization subpart
Yes

Provider details

NPI number
Legal business name
ST PETER EYECARE CENTER, INC
Authorized official
DR. BLAKE THOMAS DIRKS OD (OPTOMETRIST)
(507) 931-6436
Entity
Organization

Contact information

Practice address
1 E MINNESOTA ST, LE CENTER, MN 56057-1501
(507) 357-6665
Mailing address
320 SUNRISE DR, SAINT PETER, MN 56082-1352
(507) 931-6436
(507) 934-9625

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2076
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0322460001
DMERC
MN
01
114338
UCARE
MN
01
15568
HEALTH PARTNERS
MN
01
2200871
MEDICA
MN
01
33077DI
BLUE CROSS BLUE SHIELD
MN
01
44977TH
BLUEPLUS EYEWEAR
MN
05
706140400
MN
01
C06707
MEDICARE
MN
Enumeration date
01/22/2007
Last updated
06/18/2008
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