NPIMap

Organization Active NPI

Columbia Park Medical Group, PA

  • Eyewear Supplier
  • Fridley, MN
National Provider Identifier
1205933611
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
COLUMBIA PARK MEDICAL GROUP, PA
Practice address
6341 University Ave NE
Fridley, MN 55432-4946
Phone
(763) 572-5718
Fax
(763) 572-0318
NPI assigned
Sep 20, 2006
Last updated
Nov 13, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
COLUMBIA PARK MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Joen V Condon
Title
Chief Financial Officer
Phone
(763) 586-5839

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X MN Primary

Addresses

Primary practice location

6341 University Ave NE
Fridley, MN 55432-4946

Mailing address

6401 University Ave NE
Fridley, MN 55432-4341
Phone (763) 572-5710

Other identifiers 4

IdentifierTypeStateIssuer
5C734COOtherMNBCBS EYEWARE
21140OtherMNMEDICA EYEWARE
21-00011OtherMNEYECRAFT LAB
126906OtherMNUCARE EYEWARE

Other names 1

  • Fridley Plaza - Eyeware Other name

National Provider Directory

National Provider Directory
Tax ID family
Andover Park Clinic12 organizations share this tax ID, including this one
Part of
Andover Park Clinic

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1205933611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324341",
            "telephone_number": "763-572-5710",
            "fax_number": "763-571-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6341 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324946",
            "telephone_number": "763-572-5718",
            "fax_number": "763-572-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBIA PARK MEDICAL GROUP",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "JOEN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "763-586-5839"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS EYEWARE",
            "identifier": "5C734CO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA EYEWARE",
            "identifier": "21140",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYECRAFT LAB",
            "identifier": "21-00011",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE EYEWARE",
            "identifier": "126906",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fridley Plaza - Eyeware",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.