NPIMap

Organization Active NPI

Thomas L Nunnelee Inc

Doing business as Princeton Vision Center

  • Eyewear Supplier
  • Princeton, MN
National Provider Identifier
1225194475
Registry record updated Mar 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
THOMAS L NUNNELEE INC
Doing business as
Princeton Vision Center
Practice address
900 Rum River Dr South
Suite 103
Princeton, MN 55371
Phone
(763) 389-9000
Fax
(763) 389-9096
NPI assigned
Dec 29, 2006
Last updated
Mar 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2008

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

Authorized official

Name
Ms. Kathryn Joella Johns
Title
Manager Optician
Phone
(763) 389-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

900 Rum River Dr South
Suite 103
Princeton, MN 55371

Mailing address

900 Rum River Dr South
Suite 103
Princeton, MN 55371
Phone (763) 389-9000

Other names 1

  • Princeton Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070604000407 MN Part B Supplier - Clinic/Group Practice 4880792571 Receives reassigned benefits from 3 practitioners
Practice locations: Princeton, MN
O20100930099403 MN DME Supplier - Optician 4880792571 Practice locations: Princeton, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Princeton Vision Center900 S Rum River Dr, Princeton, MN 55371-2245(763) 389-9000 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jun 6, 1994

National Provider Directory

National Provider Directory

Locations

900 S Rum River Dr
Princeton, MN 55371
Phone (763) 389-9000

900 S Rum River Dr
Ste 103
Princeton, MN 55371
Phone (763) 389-9000

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205971200000",
    "number": "1225194475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RUM RIVER DR SOUTH",
            "address_2": "SUITE 103",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "55371",
            "telephone_number": "763-389-9000",
            "fax_number": "763-389-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 RUM RIVER DR SOUTH",
            "address_2": "SUITE 103",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "55371",
            "telephone_number": "763-389-9000",
            "fax_number": "763-389-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS L NUNNELEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2008-03-20",
        "status": "A",
        "authorized_official_last_name": "JOHNS",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "JOELLA",
        "authorized_official_title_or_position": "MANAGER OPTICIAN",
        "authorized_official_telephone_number": "763-389-9000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Princeton Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.