Provider Demographics
NPI:1679640221
Name:FOR YOUR EYES ONLY
Entity type:Organization
Organization Name:FOR YOUR EYES ONLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-424-1206
Mailing Address - Street 1:20 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1241
Mailing Address - Country:US
Mailing Address - Phone:763-424-1206
Mailing Address - Fax:763-424-6838
Practice Address - Street 1:20 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1241
Practice Address - Country:US
Practice Address - Phone:763-424-1206
Practice Address - Fax:763-424-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1670152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN564723100Medicaid
T39846Medicare UPIN
MN564723100Medicaid