Provider Demographics
NPI:1316955941
Name:WHELAN EYE CARE, INC.
Entity type:Organization
Organization Name:WHELAN EYE CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-306-8300
Mailing Address - Street 1:1900 DIVISION ST W
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6396
Mailing Address - Country:US
Mailing Address - Phone:218-759-1430
Mailing Address - Fax:218-444-9086
Practice Address - Street 1:1900 DIVISION ST W UNIT 5
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6397
Practice Address - Country:US
Practice Address - Phone:218-759-1430
Practice Address - Fax:218-444-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2110152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN933718100Medicaid
MN548523100Medicaid
0916440001Medicare NSC
410001230Medicare PIN
MNC02653Medicare ID - Type UnspecifiedPROVIDER ID
T63655Medicare UPIN