NPIMap

Organization Active NPI

Sanford Health of Northern Minnesota

Doing business as Sanford Health 1611 Eye Center & Optical

  • Ophthalmology Physician
  • Bemidji, MN
National Provider Identifier
1154587780
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SANFORD HEALTH OF NORTHERN MINNESOTA
Doing business as
Sanford Health 1611 Eye Center & Optical
Practice address
1611 Anne St NW
Ste 7
Bemidji, MN 56601-5114
Phone
(218) 333-2020
Fax
(218) 333-2019
NPI assigned
Aug 4, 2008
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Tony Lee Morrison
Title
Vice President, Revenue Cycle
Phone
(605) 328-8380

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

1611 Anne St NW
Ste 7
Bemidji, MN 56601-5114

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Other practice location 1

1611 Anne St NW Ste 7
Bemidji, MN 56601-5114
Phone (218) 333-2020

Other names 1

  • Sanford Health 1611 Eye Center & Optical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161107000182 MN DME Supplier - Physician - OptometristDME Supplier - Optician 5597725168 Practice locations: Bemidji, MN

Other NPIs with the same Medicare PAC ID 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
North Country Health SE23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 2

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

Locations

123 4th St NW
Bagley, MN 56621
Phone (218) 694-2384

14 2nd St NE
Bagley, MN 56621
Phone (218) 694-2442

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1611 Anne St NW
Ste 7
Bemidji, MN 56601
Phone (218) 333-2020

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1154587780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 ANNE ST NW",
            "address_2": "STE 7",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015114",
            "telephone_number": "218-333-2020",
            "fax_number": "218-333-2019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1611 Anne St NW Ste 7",
            "address_purpose": "LOCATION",
            "city": "Bemidji",
            "state": "MN",
            "postal_code": "566015114",
            "country_code": "US",
            "telephone_number": "218-333-2020",
            "fax_number": "218-333-2019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD HEALTH OF NORTHERN MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VICE PRESIDENT, REVENUE CYCLE",
        "authorized_official_telephone_number": "605-328-8380"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sanford Health 1611 Eye Center & Optical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Health 1611 Eye Center & Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bemidji, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.