Eagan Eye Clinic LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EAGAN EYE CLINIC LLC

Practice address

204 Washburne Ave
Paynesville, MN 56362-1643

Phone

(320) 204-6400

NPI assigned

Oct 2, 2020

Last updated

Oct 2, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

EAGAN EYE CLINIC LLCAs reported in NPPES

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

Authorized official

Name

Benjamin S. Chudner, OD

Title

President

Phone

(972) 370-5552

Specialties & licenses 1

Addresses

Part of

Eagan Eye Clinic LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Eagan Eye Clinic LLC

  • Optometrist
  • Eagan, MN
  • NPI 1477732337
  NPPES parent name

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1194322131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E BROADWAY",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026220",
            "telephone_number": "618-462-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 WASHBURNE AVE",
            "city": "PAYNESVILLE",
            "state": "MN",
            "postal_code": "563621643",
            "telephone_number": "320-204-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGAN EYE CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGAN EYE CLINIC LLC",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "CHUDNER",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-370-5552",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lauren A Foster
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• Optometrist in Paynesville, MN
• Providers in Paynesville, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; 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.