Michael V Dieter, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1693 Issued in MN

Practice address

12000 Elm Creek Blvd N Ste L90
Maple Grove, MN 55369-7168

Phone

(763) 416-0919

Fax

(763) 416-0992

NPI assigned

Feb 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Roseau Warroad Eye Clinic PA

  • Optometrist
  • Roseau, MN
  • NPI 1396148839
  NPD (past)
• Roseau/Warroad Eye Clinic, P.a.

  • Optometrist
  • Warroad, MN
  • NPI 1861562340
  NPD (past)

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1245374115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N STE L90",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697168",
            "telephone_number": "763-416-0919",
            "fax_number": "763-416-0992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N STE L90",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697168",
            "telephone_number": "763-416-0919",
            "fax_number": "763-416-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETER",
        "first_name": "MICHAEL",
        "middle_name": "V",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1396DI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "844323800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Safiatou Diallo
• Thaily Diaz Fleites, DDS
• Marie A Diaz Varona, PSYD, LP
• Catherine Didur
• Bridgett Ann Diers, PT, DPT, ATC
• Digestive Endoscopy, PA
• Emma Nicole Dilks Kuchera
• Bethany R Dillon, MA, LPCC, CCTP
• Distinctive Eyewear, LLC
• Diversey Home Care, LLC

• Optometrist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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.