Icare Family Vision PLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3225 Issued in MN

Legal business name

ICARE FAMILY VISION PLC

Practice address

6900 W Lake St
St Louis Park, MN 55426-4209

Phone

(952) 222-3578

NPI assigned

Dec 1, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth JohnsonNPI 1760610174

Title

Owner

Phone

(952) 222-3578

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth M Johnson, OD

  • Optometrist
  • St Louis Park, MN
  • NPI 1760610174
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1003359597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 W LAKE ST",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264209",
            "telephone_number": "952-222-3578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 W LAKE ST",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264209",
            "telephone_number": "952-222-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARE FAMILY VISION PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-01",
        "last_updated": "2022-10-25",
        "certification_date": "2022-07-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-222-3578"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.