Annandale Eye Clinic Inc
Organization Active NPI Optometrist · Litchfield, MN
NPI 1992995658 · NPPES record last updated Jul 14, 2009
Key facts
- NPI
- 1992995658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1765 (MN)
- Legal business name
- ANNANDALE EYE CLINIC INC
- Practice address
- 135 N Sibley Ave
Litchfield, MN 55355-2138 - Phone
- (320) 593-3100
- NPI assigned
- Jul 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Terrence Lee Tancabel, O.D.
- Title
- Ceo
- Phone
- (320) 274-3701
Other NPIs on the same Medicare enrollment 1
Practitioners 5
-
Anna Claire Aho, OD
-
Blake Kvidt, OD
-
Amy J Nyquist, O.D.
-
Katie Nicole Tancabel, O.D.
-
Terrence L Tancabel, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2264426 | Litchfield Eye Center | Certificate of waiver | Jul 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070122000134 | MN | Part B Supplier - Clinic/Group Practice | 6800897661 |
Receives reassigned benefits from 5 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Annandale, MN; Litchfield, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1765 | MN | Yes |
Addresses
Primary practice location
135 N Sibley Ave
Litchfield, MN 55355-2138
Mailing address
135 N Sibley Ave
Litchfield, MN 55355-2138
Other names
- Litchfield Eye Center
Other providers in Litchfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.