Michael S Petronack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2544 Issued in MN

Practice address

5679 147TH St N
Hugo, MN 55038-9302

Phone

(651) 762-9545

Fax

(651) 762-9542

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eagan Eye Clinic LLCGroup PAC ID 0345220745, 48 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Eagan Eye Clinic LLC

  • Optometrist
  • Eagan, MN
  • NPI 1477732337
  Medicare reassignment Care Compare group NPD
• Eagan Eye Clinic LLC

  • Optometrist
  • Becker, MN
  • NPI 1023615069
  NPD

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1295891596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5679 147TH ST N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550389302",
            "telephone_number": "651-762-9545",
            "fax_number": "651-762-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5679 147TH ST N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550389302",
            "telephone_number": "651-762-9545",
            "fax_number": "651-762-9542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONACK",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3868206-00",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oneka Chiropractic, PA
• Liza Milagros Ortiz, M.D., M.P.H.
• Rebecca Pankratz, PA-C
• PDG, P.a.
• Tammy Marie Peterson, MA, LADC, LPCC
• Arlie Jean Post, PTA
• Productive Relaxation Massage LLC
• Katy Ras, PHARM D
• Alec James Rautenberg
• Nicole E Riley, NNP

• Optometrist in Hugo, MN
• Providers in Hugo, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.