Active NPI
Vandesteeg & Larson Optometric Clinic, PA
Doing business as Glacial Ridge Eye Clinic
- Eyewear Supplier
- Glenwood, MN
National Provider Identifier
1174929160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- VANDESTEEG & LARSON OPTOMETRIC CLINIC, PA
- Doing business as
- Glacial Ridge Eye Clinic
- Practice address
- 24 1St St SE
Glenwood, MN 56334-1619 - Phone
- (320) 634-4516
- Fax
- (320) 634-4520
- NPI assigned
- Nov 18, 2014
- Last updated
- Jul 16, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jonathan D Larson, OD
- Title
- Owner
- Phone
- (320) 634-4516
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Eyewear Supplier | 332H00000X | Primary |
Addresses
Primary practice location
24 1St St SE
Glenwood, MN 56334-1619
Mailing address
24 1St Street SE
Glenwood, MN 56334
Phone (320) 634-4516
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10000202944 | Medicaid | MN | |
| 496063700 | Medicaid | MN |
Other names 1
- Glacial Ridge Eye Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050712000500 | MN | Part B Supplier - Clinic/Group Practice | 6800822859 |
Receives reassigned benefits from 2 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Glenwood, MN; Long Prairie, MN; Sauk Centre, MN |
| O20151102001190 | MN | DME Supplier - Physician - Optometrist | 6800822859 | Practice locations: Glenwood, MN |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Optometrist
- Long Prairie, MN
- NPI 1669944104
O20050712000500
Laboratory certificates & supplier records
Derived by NPIMapThese 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
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Glacial Ridge Eye Clinic | Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Vandesteeg Larson Optomet
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Glacial Ridge Eye Clinic
- Optometrist
- Glenwood, MN
- NPI 1922401694
-
- Optometrist
- Long Prairie, MN
- NPI 1669944104
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416268800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1752624000000",
"number": "1174929160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 1ST STREET SE",
"city": "GLENWOOD",
"state": "MN",
"postal_code": "56334",
"telephone_number": "320-634-4516",
"fax_number": "320-634-4520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 1ST ST SE",
"city": "GLENWOOD",
"state": "MN",
"postal_code": "563341619",
"telephone_number": "320-634-4516",
"fax_number": "320-634-4520"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VANDESTEEG & LARSON OPTOMETRIC CLINIC, PA",
"organizational_subpart": "NO",
"enumeration_date": "2014-11-18",
"last_updated": "2025-07-16",
"certification_date": "2025-07-16",
"status": "A",
"authorized_official_last_name": "LARSON",
"authorized_official_first_name": "JONATHAN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "320-634-4516",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10000202944",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "496063700",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Glacial Ridge Eye Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Glacial Ridge Eye Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Glenwood, MN
- Trumm Drug, Inc. (Trumm Drug Glenwood)
- Trumm Drug, Inc. (Trumm Drug Glenwood)
- Unity Recovery LLC
- Jessica Mae Vanderhagen, FNP-C
- Vandesteeg & Larson Optometric Clinic PA (Glacial Ridge Eye Clinic)
- Amanda Volesky, PT, DPT
- Nikki Wait
- Tayler Waldvogel, M.S. LADC, LPCC
- Carl Stephen Wallin, D.D.S.
- Western Prairie Human Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.