Mille Lacs Family Eye Care

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

MILLE LACS FAMILY EYE CARE

Practice address

270 N Main St
Wahkon, MN 56386-4401

Phone

(320) 495-3500

Fax

(320) 495-3502

NPI assigned

Jun 15, 2010

Organization subpart

No

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

Authorized official

Name

Jacqueline C HonstromNPI 1760709125

Title

Owner/Operator

Phone

(320) 495-3500

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 4

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

• Jacqueline Caryn Honstrom

  • Optician
  • Wahkon, MN
  • NPI 1760709125
  NPD (past) Authorized official
• Scott Fontana, O.D.

  • Optometrist
  • Lakeville, MN
  • NPI 1922195635
  NPD (past)
• Danise Joann Miller, OD

  • Optometrist
  • Little Falls, MN
  • NPI 1083603831
  NPD (past)
• Susan Tesch, O.D.

  • Vision Therapy Optometrist
  • Bemidji, MN
  • NPI 1164525044
  NPD (past)

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

{
    "created_epoch": "1276560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277251200000",
    "number": "1255652137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39",
            "city": "WAHKON",
            "state": "MN",
            "postal_code": "563860039",
            "telephone_number": "320-495-3500",
            "fax_number": "320-495-3502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 N MAIN ST",
            "city": "WAHKON",
            "state": "MN",
            "postal_code": "563864401",
            "telephone_number": "320-495-3500",
            "fax_number": "320-495-3502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLE LACS FAMILY EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-15",
        "last_updated": "2010-06-23",
        "status": "A",
        "authorized_official_last_name": "HONSTROM",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "320-495-3500"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760709125",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Caryn Honstrom

• All providers in Wahkon, MN
• Optician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; 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.