Provider Demographics
NPI:1962537134
Name:STEWART EYECARE, INC.
Entity type:Organization
Organization Name:STEWART EYECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKKE
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:507-645-2020
Mailing Address - Street 1:2019 JEFFERSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3258
Mailing Address - Country:US
Mailing Address - Phone:507-645-9202
Mailing Address - Fax:507-645-9203
Practice Address - Street 1:2019 JEFFERSON ROAD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-744-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21-00718OtherMEDICA
MN164416OtherUCARE OF MINNESOTA
MN594K8RIOtherBLUE CROSS BLUE SHIELD MN
MN164416OtherUCARE OF MINNESOTA