NPIMap

Organization Active NPI

St Anthony Optometric Clinic

  • Primary Care Clinic/Center
  • St Anthony, MN
National Provider Identifier
1205953437
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
2443 Issued in MN
Legal business name
ST ANTHONY OPTOMETRIC CLINIC
Practice address
2929 Pentagon Dr
St Anthony, MN 55418-3208
Phone
(612) 781-4730
Fax
(612) 706-2337
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Todd Jeffrey Hanson, ODNPI 1740344894
Title
President Owner
Phone
(612) 781-4730

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 2443 MN Primary

Addresses

Primary practice location

2929 Pentagon Dr
St Anthony, MN 55418-3208

Mailing address

2929 Pentagon Dr
St Anthony, MN 55418-3208
Phone (612) 781-4730

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329000508 MN Part B Supplier - Clinic/Group Practice 2163314600 Receives reassigned benefits from 3 practitioners
Practice locations: St Anthony, MN

National Provider Directory

National Provider Directory

Locations

2929 Pentagon Dr
St Anthony, MN 55418
Phone (612) 781-4730

Practitioners & affiliated clinicians

Practitioners 3

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": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205953437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 PENTAGON DR",
            "city": "ST ANTHONY",
            "state": "MN",
            "postal_code": "554183208",
            "telephone_number": "612-781-4730",
            "fax_number": "612-706-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 PENTAGON DR",
            "city": "ST ANTHONY",
            "state": "MN",
            "postal_code": "554183208",
            "telephone_number": "612-781-4730",
            "fax_number": "612-706-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST ANTHONY OPTOMETRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "612-781-4730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": "2443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Anthony, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.