Vivid Vision Care, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

750 Issued in ND

Legal business name

VIVID VISION CARE, PLLC

Practice address

3265 45TH St S Ste 104
Fargo, ND 58104-7930

Phone

(701) 741-2951

NPI assigned

Jul 24, 2018

Organization subpart

No

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

Authorized official

Name

Erin Barrett, ODNPI 1679808752

Title

Owner

Phone

(701) 741-2951

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

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.

• Erin L Barrett, OD

  • Optometrist
  • Fargo, ND
  • NPI 1679808752

  ND

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532390400000",
    "number": "1003393828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3265 45TH ST S STE 104",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3265 45TH ST S STE 104",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047930",
            "telephone_number": "701-741-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVID VISION CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A",
        "authorized_official_last_name": "BARRETT",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-741-2951",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ND",
            "license": "750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1473399",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fargo, ND
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.