| |
512 Atlantic Ave, Morris, MN 56267 | |
(320) 589-1300 | |
(320) 589-3348 |
Full Name | |
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Type | Facility |
Speciality | Technician/technologist - Optician |
Location | 512 Atlantic Ave, Morris, Minnesota |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1073682191 | NPI | - | NPPES |
07763K1 | Other | MN | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
156FX1800X | Technician/technologist - Optician | (* (Not Available)) | Primary |
Provider Name | Joseph J Kisch |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1982713012 PECOS PAC ID: 5799767919 Enrollment ID: I20040602000943 |
Provider Name | Jenna K Backowski |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1831502244 PECOS PAC ID: 8820212525 Enrollment ID: I20140620000095 |
Mailing Address | Practice Location Address |
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Po Box 456, St. Cloud, MN 56302 Ph: (320) 252-5777 | 512 Atlantic Ave, Morris, MN 56267 Ph: (320) 589-1300 |