Active NPI
Charles Lannom, OD
- Optometrist
- Eden Prairie, MN
National Provider Identifier
1205823648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1825
- Practice address
- 16550 W 78TH St
Suite a
Eden Prairie, MN 55346-4315 - Phone
- (952) 934-6926
- Fax
- (952) 934-3402
- NPI assigned
- Sep 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1825 | MN | Primary |
Addresses
Primary practice location
16550 W 78TH St
Suite a
Eden Prairie, MN 55346-4315
Mailing address
16550 W 78TH St
Suite a
Eden Prairie, MN 55346-4315
Phone (952) 934-6926
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1825 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719792000000",
"number": "1205823648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16550 W 78TH ST",
"address_2": "SUITE A",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553464315",
"telephone_number": "952-934-6926",
"fax_number": "952-934-3402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16550 W 78TH ST",
"address_2": "SUITE A",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553464315",
"telephone_number": "952-934-6926",
"fax_number": "952-934-3402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANNOM",
"first_name": "CHARLES",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-30",
"last_updated": "2024-07-01",
"certification_date": "2024-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.