North Suburban Optical

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

NORTH SUBURBAN OPTICAL

Doing business as

Optical Studios

Practice address

11855 Ulysses St
Suite 140
Blaine, MN 55434

Phone

(763) 421-7420

Fax

(763) 421-0730

NPI assigned

Jun 22, 2007

Organization subpart

No

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

Authorized official

Name

Mark C Lobanoff, MD

Title

MD/Owner

Phone

(763) 421-7420

Specialties & licenses 1

Addresses

Other names 1

• Optical Studios Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• North Suburban Optical

  dba Optical Studios

  • Eyewear Supplier
  • Coon Rapids, MN
  • NPI 1730386723

  6305181561

  Same PAC ID

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

Medicare medical equipment & supply locations

Tax ID family

North Suburban Optical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• North Suburban Optical

  dba Optical Studios

  • Eyewear Supplier
  • Coon Rapids, MN
  • NPI 1730386723
  NPD tax ID

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

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543795200000",
    "number": "1306042817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3777 COON RAPIDS BLVD NW # 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332630",
            "telephone_number": "763-421-8524",
            "fax_number": "763-421-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 ULYSSES ST",
            "address_2": "SUITE 140",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55434",
            "telephone_number": "763-421-7420",
            "fax_number": "763-421-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUBURBAN OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-22",
        "last_updated": "2018-12-03",
        "status": "A",
        "authorized_official_last_name": "LOBANOFF",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "763-421-7420",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optical Studios",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optical Studios",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Northland Endodontics PA
• Northland Hearing Center Inc (Pin Drop Hearing)

• Eyewear Supplier in Blaine, MN
• Providers in Blaine, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2018; 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.