Eye Q Optometric Clinic, Limited

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

2529 Issued in MN

Legal business name

EYE Q OPTOMETRIC CLINIC, LIMITED

Practice address

201 NW 4TH St
Suite 107
Grand Rapids, MN 55744-2753

Phone

(218) 326-9619

NPI assigned

Oct 4, 2007

Organization subpart

No

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

Authorized official

Name

Darwin DalenNPI 1417954553

Title

Owner

Phone

(218) 326-9619

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Locations

Practitioners 1

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

• Darwin Dalen, O.D.

  • Optometrist
  • Grand Rapids, MN
  • NPI 1417954553
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464048000000",
    "number": "1245428135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NW 4TH ST",
            "address_2": "SUITE 107",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442753",
            "telephone_number": "218-326-9619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 NW 4TH ST",
            "address_2": "SUITE 107",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442753",
            "telephone_number": "218-326-9619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE Q OPTOMETRIC CLINIC, LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2016-05-24",
        "status": "A",
        "authorized_official_last_name": "DALEN",
        "authorized_official_first_name": "DARWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-326-9619"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": "2529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "U58324",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5C956EY",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "1245428135",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "C04933",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "C04933",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Walsh Erickson, LADC
• Troy Dewayne Erickson
• Olivia Ann Erven, PA-C
• Essentia Health Surgery Centers-Minnesota LLC
• Eye Fashions Optical Shoppe Inc
• Fairview Pharmacy Services LLC
• Donald Farnsworth, PHD
• FCSL Grand Rapids, LLC
• FCSL Grand Rapids, LLC
• Kathleen Marie Feldt

• Eyewear Supplier in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; 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.