NPIMap

Organization Active NPI

Pinecone Vision Center, PA

Doing business as PineCone Vision Center St. Cloud

  • Optometrist
  • Saint Cloud, MN
National Provider Identifier
1295468098
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PINECONE VISION CENTER, PA
Doing business as
PineCone Vision Center St. Cloud
Practice address
3274 Nottingham Rd S
St. Cloud, MN 56301
Phone
(320) 258-3915
Fax
(320) 258-3917
NPI assigned
Jul 8, 2022
Last updated
Jul 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Authorized official

Name
Christina HauxNPI 1780463968
Title
Manager
Phone
(320) 258-3915

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 1

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

Addresses

Primary practice location

3274 Nottingham Rd S
St. Cloud, MN 56301

Mailing address

2180 Troop Dr
Sartell, MN 56377-4582
Phone (320) 258-3915

Other identifiers 1

IdentifierTypeStateIssuer
1790830701MedicaidMN

Other names 1

  • PineCone Vision Center St. Cloud Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address chenry@pineconevisioncenter.eyefinityEHR.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000822 MN Part B Supplier - Clinic/Group Practice 6800786906 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Cloud, MN; Sartell, MN

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2272754Pinecone Vision Center3274 Nottingham Rd S, Saint Cloud, MN 56301Certificate of waiverNov 28, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pinecone Vision Center PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Interoperability endpoints

  • Direct secure messaging: chenry@pineconevisioncenter.eyefinityehr.com

Practitioners & affiliated clinicians

Practitioners 8

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": "1657238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1295468098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 TROOP DR",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774582",
            "telephone_number": "320-258-3915",
            "fax_number": "320-258-3917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3274 NOTTINGHAM RD S",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "56301",
            "telephone_number": "320-258-3915",
            "fax_number": "320-258-3917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINECONE VISION CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-08",
        "last_updated": "2022-07-08",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "HAUX",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "320-258-3915"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790830701",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "chenry@pineconevisioncenter.eyefinityEHR.com",
            "affiliation": "N",
            "address_1": "3274 Nottingham Rd S",
            "city": "St. Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "56301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "PineCone Vision Center St. Cloud",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.