Individual provider Active NPI

Erin Carlson, OD

  • Optometrist
  • Eagan, MN
National Provider Identifier
1174528608
Registry record updated Jul 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2727 Issued in MN
Practice address
3930 Cedar Grove Pkwy
Eagan, MN 55122-1403
Phone
(651) 454-5661
Fax
(651) 454-5669
NPI assigned
Jun 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2727 MN Primary

Addresses

Primary practice location

3930 Cedar Grove Pkwy
Eagan, MN 55122-1403

Mailing address

3930 Cedar Grove Pkwy
Eagan, MN 55122-1403
Phone (651) 454-5661

Other identifiers 1

IdentifierTypeStateIssuer
207248300MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111221000378 MN Practitioner - Optometry 3678749652 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chu Laser Eye Institute, PAGroup PAC ID 4082644786, 6 clinicians

Practice addresses (Care Compare)

9117 Lyndale Ave S
Bloomington, MN 55420-3522
Phone (952) 835-1235

Merit-based Incentive Payment System (MIPS)

Final score
92.88 of 100Reported as group
Quality
100
Improvement activities
40
Cost
76.25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2727MNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eagan Eye Clinic LLC Optometrist CurrentSince Mar 15, 2001 Accepting new patients
Eagan Eye Clinic LLC Optometrist CurrentSince Mar 15, 2001 Accepting new patients
Chu Laser Eye Institute, PA CurrentSince Aug 18, 2020 Accepting new patients
Minnesota Vision Outreach, Inc Optometrist Past Accepting new patients

Locations

9117 Lyndale Ave S
Minneapolis, MN 55420
Phone (952) 835-1235

3930 Cedar Grove Pkwy
Saint Paul, MN 55122
Phone (612) 454-5661

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217376000000",
    "number": "1174528608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 CEDAR GROVE PKWY",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221403",
            "telephone_number": "651-454-5661",
            "fax_number": "651-454-5669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 CEDAR GROVE PKWY",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221403",
            "telephone_number": "651-454-5661",
            "fax_number": "651-454-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "ERIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-21",
        "last_updated": "2008-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207248300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.