Active NPI
Moulay Younes Elidrissi
- Optometrist
- Minneapolis, MN
National Provider Identifier
1053824045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0000
- Practice address
- 720 W Lake St # 107
Minneapolis, MN 55408-2963 - Phone
- (612) 216-4705
- NPI assigned
- Nov 13, 2017
- 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 | 0000 | MN | Primary |
Addresses
Primary practice location
720 W Lake St # 107
Minneapolis, MN 55408-2963
Mailing address
720 W Lake St # 107
Minneapolis, MN 55408-2963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyeswear | Past | Accepting new patients |
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.
-
- Ophthalmologic Surgery Clinic/Center
- Minneapolis, MN
- NPI 1073020681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510531200000",
"number": "1053824045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 W LAKE ST # 107",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554082963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 W LAKE ST # 107",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554082963",
"telephone_number": "612-216-4705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELIDRISSI",
"first_name": "MOULAY YOUNES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-13",
"last_updated": "2017-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "0000",
"primary": true
}
],
"identifiers": [],
"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 Nov 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.