Ka Bloomquist RG Bakewell OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

KA BLOOMQUIST RG BAKEWELL OD PA

Doing business as

Eye Associates of Alexandria

Practice address

120 12TH Ave E
Alexandria, MN 56308

Phone

(320) 763-4321

Fax

(320) 763-6921

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John D Hoven, OD

Title

President

Phone

(320) 763-4321

Specialties & licenses 1

Addresses

Other identifiers 10

Other names 1

• Eye Associates of Alexandria Doing business as

Locations

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1093891624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 789",
            "address_2": "120 12TH AVE E",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-4321",
            "fax_number": "320-763-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 12TH AVE E",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-4321",
            "fax_number": "320-763-6921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KA BLOOMQUIST RG BAKEWELL OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "HOVEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-763-4321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIMEWEST",
            "identifier": "030701053",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "96477",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "942812700",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "121754",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4C196BL",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CG3570",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "61045BL",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0373300001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "5982",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2115931",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Associates of Alexandria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shelby Elisha Johnsrud, D.C.
• Rebecca Joyce, FNP
• Allison Marie Homstad Juba, DO
• Jennifer Jurchenko
• Adam Jurgens
• Kalon Prep Academy
• Pamela Marie Kamholz, RN
• Hannah Katnis, LPCC, LADC
• Jenna L Kavanagh, LADC
• Lourdes Mae Kavanagh, MSW, LICSW

• Optometrist in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.