Organization Active NPI

Sundell Eye Associates, PA

  • Ophthalmology Physician
  • Virginia, MN
National Provider Identifier
1093027112
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SUNDELL EYE ASSOCIATES, PA
Practice address
602 N 6TH Ave
Virginia, MN 55792-2339
Phone
(218) 741-4411
Fax
(218) 741-8966
NPI assigned
Jul 6, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

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

Authorized official

Name
Dr. Bridget Ann Sundell, M.D.NPI 1871691295
Title
Owner
Phone
(218) 741-4411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

602 N 6TH Ave
Virginia, MN 55792-2339

Mailing address

602 N 6TH Ave
Virginia, MN 55792-2339
Phone (218) 741-4411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101025000902 MN Part B Supplier - Clinic/Group Practice 3971796723 Receives reassigned benefits from 3 practitioners
Practice locations: Virginia, MN

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2111608Sundell Eye Associates602 North 6TH Ave West, Virginia, MN 55792Certificate of waiverApr 10, 2028

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

602 N 6th Ave
Virginia, MN 55792
Phone (218) 741-4111

Interoperability endpoints

  • Direct secure messaging: bsundell@sundelleye.intellechartdirect.net
  • Direct secure messaging: keckstein@sundelleye.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680048000000",
    "number": "1093027112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 N 6TH AVE",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922339",
            "telephone_number": "218-741-4411",
            "fax_number": "218-741-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N 6TH AVE",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922339",
            "telephone_number": "218-741-4411",
            "fax_number": "218-741-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDELL EYE ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-06",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A",
        "authorized_official_last_name": "SUNDELL",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-741-4411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.