NPIMap

Organization Active NPI

Cornea and Contact Lens Institute of Minnesota

  • Optometrist
  • Edina, MN
National Provider Identifier
1265733471
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
LD2631
Legal business name
CORNEA AND CONTACT LENS INSTITUTE OF MINNESOTA
Practice address
5137 Gus Young LN
Edina, MN 55436-1530
Phone
(952) 641-6226
NPI assigned
Nov 4, 2010
Last updated
Mar 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

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

Authorized official

Name
Jason Jedlicka, ODNPI 1669484622
Title
Owner
Phone
(952) 641-6226

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X LD2631 Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 44481 MN

Addresses

Primary practice location

5137 Gus Young LN
Edina, MN 55436-1530

Mailing address

PO Box 1170
Maple Grove, MN 55311-6170
Phone (763) 746-2094

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110318000159 MN Part B Supplier - Clinic/Group Practice 8729261482 Receives reassigned benefits from 3 practitioners
Practice locations: Edina, MN

National Provider Directory

National Provider Directory

Locations

5201 Eden Ave
Ste 150
Minneapolis, MN 55436
Phone (952) 300-2151

Practitioners & affiliated clinicians

Practitioners 6

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": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1265733471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1170",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553116170",
            "telephone_number": "763-746-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5137 GUS YOUNG LN",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361530",
            "telephone_number": "952-641-6226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNEA AND CONTACT LENS INSTITUTE OF MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-04",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "JEDLICKA",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-641-6226",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": "LD2631",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "44481",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.