Active NPI
Theodore Lester Hansen, OD
- Optometrist
- Minneapolis, MN
National Provider Identifier
1013018100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2086
- Practice address
- 115 East Lake St
Minneapolis, MN 55408 - Phone
- (612) 827-3857
- Fax
- (612) 827-7204
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2086 | MN | Primary |
Addresses
Primary practice location
115 East Lake St
Minneapolis, MN 55408
Mailing address
115 East Lake St
Minneapolis, MN 55408
Phone (612) 827-3857
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85750HA | Other | MN | BLUE CROSS BLUE SHIELD |
| 922371040939 | Other | MN | PREFERRED ONE |
| 2213318 | Other | MN | MEDICA |
| 102434 | Other | MN | UCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2086 | MN | MD | Physician Assistant |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optician
- Minneapolis, MN
- NPI 1528169661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013018100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 EAST LAKE ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55408",
"telephone_number": "612-827-3857",
"fax_number": "612-827-7204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 EAST LAKE ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55408",
"telephone_number": "612-827-3857",
"fax_number": "612-827-7204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "THEODORE",
"middle_name": "LESTER",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2086",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "85750HA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "922371040939",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2213318",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "102434",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.