NPIMap

Organization Active NPI

The Spectacle Shoppe Inc

  • Optometrist
  • Burnsville, MN
National Provider Identifier
1235457722
Registry record updated May 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0136 Issued in MN
Legal business name
THE SPECTACLE SHOPPE INC
Practice address
1178 Burnsville Ctr
Suite 201
Burnsville, MN 55306-6218
Phone
(952) 892-6666
Fax
(952) 892-6876
NPI assigned
May 10, 2010
Organization subpart
Yes
Parent organization
THE SPECTACLE SHOPPE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2010

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

Authorized official

Name
Mr. David Ulrich
Title
Owner
Phone
(651) 636-3434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 0136 MN Primary

Addresses

Primary practice location

1178 Burnsville Ctr
Suite 201
Burnsville, MN 55306-6218

Mailing address

1178 Burnsville Ctr
Suite 201
Burnsville, MN 55306-6218
Phone (952) 892-6666

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100923001128 MN Part B Supplier - Clinic/Group Practice 1153447453 Receives reassigned benefits from 8 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minneapolis, MN; New Brighton, MN; Saint Paul, MN; St Louis Park, MN

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Spectacle Shoppe Inc6 organizations share this tax ID, including this one
Part of
Spectacle Shoppe Inc

Other organizations with this tax ID 5

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

Locations

1178 Burnsville Ctr
Ste 201
Burnsville, MN 55306
Phone (952) 892-6666

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1273449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273449600000",
    "number": "1235457722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1178 BURNSVILLE CTR",
            "address_2": "SUITE 201",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553066218",
            "telephone_number": "952-892-6666",
            "fax_number": "952-892-6876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1178 BURNSVILLE CTR",
            "address_2": "SUITE 201",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553066218",
            "telephone_number": "952-892-6666",
            "fax_number": "952-892-6876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SPECTACLE SHOPPE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE SPECTACLE SHOPPE INC",
        "enumeration_date": "2010-05-10",
        "last_updated": "2010-05-10",
        "status": "A",
        "authorized_official_last_name": "ULRICH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-636-3434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "0136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2010; 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.