NPIMap

Organization Active NPI

Glacial Ridge Hospital District

Doing business as Glenwood Family Eye Center

  • Optometrist
  • Glenwood, MN
National Provider Identifier
1306206446
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2417 Issued in MN
Legal business name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
Glenwood Family Eye Center
Practice address
16 West Minnesota Avenue
Suite 102
Glenwood, MN 56334
Phone
(320) 334-3264
Fax
(320) 334-3256
NPI assigned
Mar 2, 2016
Last updated
Jun 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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

Authorized official

Name
Kirk A Stensrud
Title
Administrator/Ceo
Phone
(320) 634-2208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 2417 MN Primary

Addresses

Primary practice location

16 West Minnesota Avenue
Suite 102
Glenwood, MN 56334

Mailing address

16 West Minnesota Avenue
Suite 102
Glenwood, MN 56334
Phone (320) 334-3264

Other names 1

  • Glenwood Family Eye Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050719000315 MN Part B Supplier - Clinic/Group Practice 5294789194 Receives reassigned benefits from 125 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Starbuck, MN; Glenwood, MN; Brooten, MN

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1306206446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 WEST MINNESOTA AVENUE",
            "address_2": "SUITE 102",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "56334",
            "telephone_number": "320-334-3264",
            "fax_number": "320-334-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 WEST MINNESOTA AVENUE",
            "address_2": "SUITE 102",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "56334",
            "telephone_number": "320-334-3264",
            "fax_number": "320-334-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIAL RIDGE HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-02",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "STENSRUD",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "320-634-2208"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenwood Family Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenwood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; 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.