Crossroads Optometric Clinic, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0001425 Issued in MN

Legal business name

CROSSROADS OPTOMETRIC CLINIC, INC.

Doing business as

Lakeside Family Eye Care

Practice address

16250 Duluth Ave SE Ste 100
Prior Lake, MN 55372-2883

Phone

(952) 447-2020

Fax

(952) 447-2322

NPI assigned

Jul 15, 2006

Last updated

Dec 8, 2020By 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

Lisa Anne Dawson-Clausen, ODNPI 1003803677

Title

Owner/Optometrist

Phone

(952) 447-2020

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Lakeside Family Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

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.

• Lisa Anne Dawson-Clausen, O.D.

  • Optometrist
  • Prior Lake, MN
  • NPI 1003803677
  Medicare reassignment Care Compare group NPD Authorized official
• Timothy J Hurley, OD

  • Optometrist
  • Plymouth, MN
  • NPI 1518928845
  Medicare reassignment Care Compare group NPD
• Emily Ann Ufken, O.D.

  • Optometrist
  • Burnsville, MN
  • NPI 1467712133
  Medicare reassignment Care Compare group NPD
• Tara Rae Barth, O.D.

  • Corneal and Contact Management Optometrist
  • Bloomington, MN
  • NPI 1548499676
  Medicare reassignment NPD
• Kassandra M Wedeking Calarco, O.D.

  • Optometrist
  • Apple Valley, MN
  • NPI 1245671932
  Medicare reassignment NPD
• Abigail Richie Moore, O.D.

  • Optometrist
  • Eau Claire, WI
  • NPI 1316397615

  MN

  Medicare reassignment NPD
• Wayne Gene Hines, O.D.

  • Optometrist
  • Prior Lake, MN
  • NPI 1841337425
  NPD (past)
• Chad Michael Legois, O.D.

  • Optometrist
  • Fridley, MN
  • NPI 1578755088
  NPD (past)
• Gregory M Macik, OD

  • Optometrist
  • Willmar, MN
  • NPI 1922004514
  NPD (past)
• Andrew Mattson, O.D.

  • Optometrist
  • Lakeville, MN
  • NPI 1518037563
  NPD (past)

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1164448627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16250 DULUTH AVE SE STE 100",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553722883",
            "telephone_number": "952-447-2020",
            "fax_number": "952-447-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16250 DULUTH AVE SE STE 100",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553722883",
            "telephone_number": "952-447-2020",
            "fax_number": "952-447-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS OPTOMETRIC CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "DAWSON-CLAUSEN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "952-447-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "0001425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2223987",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA DME",
            "identifier": "2123989",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "4825",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-MN",
            "identifier": "51154HI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DME",
            "identifier": "3C258CR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "92364",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.