Forks Optometric, LTD.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

FORKS OPTOMETRIC, LTD.

Doing business as

Opticare

Practice address

421 Demers Ave
East Grand Forks, MN 56721-1835

Phone

(218) 773-3438

Fax

(218) 773-1645

NPI assigned

Feb 27, 2007

Last updated

Mar 6, 2012By 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. Bruce Allen Storhaug, O.D.NPI 1275561482

Title

Optometrist

Phone

(218) 773-2400

Specialties & licenses 1

Addresses

Other names 1

• Opticare Doing business as

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Forks Optometric, LTD.

  dba Opticare

  • Eyewear Supplier
  • Crookston, MN
  • NPI 1942578562

  2567365794

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Forks Optometric, LTD.

  dba Opticare

  • Eyewear Supplier
  • Crookston, MN
  • NPI 1942578562

  O20040127000855

  Same enrollment

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

Tax ID family

Forks Optometric LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Forks Optometric, LTD.

  dba Opticare

  • Eyewear Supplier
  • Crookston, MN
  • NPI 1942578562
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Forks Optometric, LTD.

  dba Opticare

  • Eyewear Supplier
  • Crookston, MN
  • NPI 1942578562
  NPPES parent name

Practitioners 3

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.

• Bruce A. Storhaug, O.D.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1275561482
  Medicare reassignment Care Compare group NPD Authorized official
• Destin Ross Coles, O.D.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1275695025
  Medicare reassignment Care Compare group NPD
• Steven Phillip Gander, O.D.

  • Optometrist
  • East Grand Forks, MN
  • NPI 1376639476
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330992000000",
    "number": "1144357211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 DEMERS AVE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211835",
            "telephone_number": "218-773-3438",
            "fax_number": "218-773-1645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 DEMERS AVE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211835",
            "telephone_number": "218-773-3438",
            "fax_number": "218-773-1645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORKS OPTOMETRIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2012-03-06",
        "status": "A",
        "authorized_official_last_name": "STORHAUG",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "218-773-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Opticare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edgewood Vista
• Terra Nicole Edwards, APRN, PMHNP-BC
• Chelsea Erickson, D.D.S.
• Sarah Erickson, DPT
• Merit FL Fondong, NP
• Hannah Stephanie Fundaun, PHARMD
• Cathy A Galstad, MS CCC/SLP
• Steven Phillip Gander, O.D.
• Mridu Gandhi, MD
• Harriet J Gibbons, PA-C

• Optometrist in East Grand Forks, MN
• Providers in East Grand Forks, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; 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.