Organization Active NPI

Advanced Eyecare

  • Optometrist
  • Grand Forks, ND
National Provider Identifier
1134463565
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
538 Issued in ND
Legal business name
ADVANCED EYECARE
Practice address
1401 28TH Ave S
Grand Forks, ND 58201-6731
Phone
(701) 757-2121
Fax
(701) 757-2120
NPI assigned
Nov 26, 2012
Last updated
May 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Authorized official

Name
Dr. Julie Ann Lagodinski, OD
Title
Optometrist
Phone
(701) 757-2121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 538 ND Primary

Addresses

Primary practice location

1401 28TH Ave S
Grand Forks, ND 58201-6731

Mailing address

1401 28TH Ave S
Grand Forks, ND 58201-6731
Phone (701) 757-2121

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130529000959 ND Part B Supplier - Clinic/Group Practice 8729226923 Receives reassigned benefits from 1 practitioner
Practice locations: Grand Forks, ND

National Provider Directory

National Provider Directory

Locations

1401 28th Ave S
Grand Forks, ND 58201
Phone (701) 757-2121

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1353888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1134463565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 28TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016731",
            "telephone_number": "701-757-2121",
            "fax_number": "701-757-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 28TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016731",
            "telephone_number": "701-757-2121",
            "fax_number": "701-757-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-26",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "LAGODINSKI",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "701-757-2121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.