Theobald Family Eye Care, LLP

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

THEOBALD FAMILY EYE CARE, LLP

Practice address

416 N Central Ave
Duluth, MN 55807-2548

Phone

(218) 624-2095

Fax

(218) 624-9545

NPI assigned

Oct 4, 2006

Last updated

Nov 24, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Teresa Theobald, O.D.NPI 1902872518

Title

Owner/Partner

Phone

(218) 624-2095

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Theobald Family Eye Care Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 4

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.

• Teresa F Theobald, O.D.

  • Optometrist
  • Duluth, MN
  • NPI 1902872518
  Medicare reassignment Care Compare group NPD Authorized official
• Whitney Page Lauer

  • Optometrist
  • Virginia, MN
  • NPI 1285164079
  Medicare reassignment Care Compare group NPD
• Martin J Theobald, O.D.

  • Optometrist
  • Duluth, MN
  • NPI 1609842210
  Medicare reassignment Care Compare group NPD
• Staci Lynn Collison

  • Optometrist
  • Bemidji, MN
  • NPI 1588949648
  Medicare reassignment NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448323200000",
    "number": "1326133497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 W ARROWHEAD RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558114000",
            "telephone_number": "218-727-6400",
            "fax_number": "218-464-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 N CENTRAL AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072548",
            "telephone_number": "218-624-2095",
            "fax_number": "218-624-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEOBALD FAMILY EYE CARE, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2015-11-24",
        "status": "A",
        "authorized_official_last_name": "THEOBALD",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "218-624-2095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402964000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS & FIRST PLAN",
            "identifier": "6C246TH",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB6890",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Theobald Family Eye Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2015; 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.