Elk River Eye Clinic, P.a.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

ELK RIVER EYE CLINIC, P.A.

Practice address

19022 Freeport Ave NW
Suite H
Elk River, MN 55330-4767

Phone

(763) 441-1055

Fax

(763) 441-7024

NPI assigned

Jun 17, 2006

Last updated

Aug 6, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gary Mark Hoffard, O.D.NPI 1366482473

Title

President

Phone

(763) 441-1055

Specialties & licenses 3

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tanya S Erntson, OD

  • Optometrist
  • Plymouth, MN
  • NPI 1700864279
  Medicare reassignment Care Compare group NPD
• Rodney Jerome Hess, OD

  • Optometrist
  • Elk River, MN
  • NPI 1730113887
  Medicare reassignment Care Compare group NPD
• Gary Mark Hoffard, O.D.

  • Optometrist
  • Elk River, MN
  • NPI 1366482473
  Authorized official Same address or phone
• Warren J Stoltman, O.D.

  • Optometrist
  • Buffalo, MN
  • NPI 1811939838
  NPD (past)

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281052800000",
    "number": "1063457943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19022 FREEPORT AVE NW",
            "address_2": "SUITE H",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553304767",
            "telephone_number": "763-441-1055",
            "fax_number": "763-441-7024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19022 FREEPORT AVE NW",
            "address_2": "SUITE H",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553304767",
            "telephone_number": "763-441-1055",
            "fax_number": "763-441-7024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK RIVER EYE CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2010-08-06",
        "status": "A",
        "authorized_official_last_name": "HOFFARD",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-441-1055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CLINIC NUMBER",
            "identifier": "98-22038",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "115815",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52390HO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379314100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "81961",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "96458",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MATERIALS",
            "identifier": "5C159EL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ6982",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA OPTICAL",
            "identifier": "21-15856",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tabitha Margaret Eiynck
• Kelsey Lee Elbert
• Elim Homes, Inc (Pro Rehab)
• Elk Plaza Dental
• Elk River Chiropractic,P.a.
• Elk River Family Dentistry
• Elk River Fire & Ambulance Service
• Elk River Foot & Ankle Clinic PA
• Elk River Municipal Utilities
• Elk River Operations, LLC (Elk River Senior Living)

• Optometrist in Elk River, MN
• Providers in Elk River, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.