Total Eye Care LLC
Organization Active NPI Ophthalmology Physician · Wyoming, MN
NPI 1124166558 · NPPES record last updated Jul 11, 2023
Key facts
- NPI
- 1124166558
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- TOTAL EYE CARE LLC
- Practice address
- 5200 Fairview Blvd
Wyoming, MN 55092-8013 - Phone
- (651) 257-8421
- Fax
- (651) 257-8464
- NPI assigned
- Feb 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Crystal Randby
- Title
- Billing
- Phone
- (651) 213-3369
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 7
-
Mary Bhavsar, M.D.
-
Gunnar Jon Erickson, M.D.
-
Todd C Kavanagh, OD
-
Jarrod Allen Nelson, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Total Eye Care LLC |
Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041210000129 | MN | Part B Supplier - Clinic/Group Practice | 8022075142 |
Receives reassigned benefits from 7 practitioners Practice locations: Blaine, MN; Wyoming, MN; Chisago City, MN; North Branch, MN |
| O20100930032820 | MN | DME Supplier - Physician - Optometrist |
8022075142 | Practice locations: Wyoming, MN |
National Provider Directory
- Tax ID family
- Total Eye Care
Locations
26263 Forest Blvd
Ste 100
Wyoming, MN 55092
26263 Forest Blvd
#300
Wyoming, MN 55092
Phone (651) 982-7720
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Ophthalmology Physician |
207W00000X | Yes |
Addresses
Primary practice location
5200 Fairview Blvd
Wyoming, MN 55092-8013
Mailing address
11725 Stinson Ave
Chisago City, MN 55013-9542
Phone (651) 257-8421
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 827983700 | Medicaid | MN |
Other names
- Total Eye Care LLC
Other providers in Wyoming, MN
- Stuart E Sybesma
- Jessica A Szmanda
- Todd Michael Thieman
- Sally Thurnbeck
- Matthew David Torgeson
- Total Renal Care Inc
- Mark G Trainor
- Antonette Trapp
- Donna Turnquist
- Megan Veenstra
All providers in Wyoming, MN · Ophthalmology Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.