NPIMap

Organization Active NPI

Waseca Optometric Center

  • Optometrist
  • Waseca, MN
National Provider Identifier
1184095671
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1592 Issued in MN
Legal business name
WASECA OPTOMETRIC CENTER
Practice address
1111 2ND St NE
Waseca, MN 56093-2416
Phone
(507) 835-2020
Fax
(507) 833-7677
NPI assigned
Oct 9, 2015
Last updated
Oct 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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

Authorized official

Name
Dr. John Max Gutfleisch, ODNPI 1437206679
Title
Owner
Phone
(507) 835-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1592 MN Primary

Addresses

Primary practice location

1111 2ND St NE
Waseca, MN 56093-2416

Mailing address

1111 2ND St NE
PO Box 464
Waseca, MN 56093-2416
Phone (507) 835-2020

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1444348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444348800000",
    "number": "1184095671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 2ND ST NE",
            "address_2": "PO BOX 464",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560932416",
            "telephone_number": "507-835-2020",
            "fax_number": "507-833-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 2ND ST NE",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560932416",
            "telephone_number": "507-835-2020",
            "fax_number": "507-833-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASECA OPTOMETRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-09",
        "last_updated": "2015-10-09",
        "status": "A",
        "authorized_official_last_name": "GUTFLEISCH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MAX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-835-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waseca, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.