LC Optometric PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

MN2638 Issued in MN

Legal business name

LC OPTOMETRIC PC

Doing business as

LensCrafters

Practice address

12131 Elm Creek Blvd N
Maple Grove, MN 55369-7093

Phone

(763) 416-1983

NPI assigned

May 9, 2008

Last updated

May 9, 2008By 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

Miss Crystal Anne Trom

Title

Buisness Manager

Phone

(763) 354-9505

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LensCrafters Doing business as

Practitioners 1

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.

• William Clifford Brose, O.D.,

  • Optometrist
  • Maple Grove, MN
  • NPI 1801933627
  NPD (past)

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1336316249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 BROOKDALE DRIVE",
            "address_2": "BROOKDALE CENTER",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "55430",
            "telephone_number": "763-560-9239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12131 ELM CREEK BLVD N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697093",
            "telephone_number": "763-416-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LC OPTOMETRIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "TROM",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "BUISNESS MANAGER",
        "authorized_official_telephone_number": "763-354-9505",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN2638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "864687200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LensCrafters",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brynne Rainier Wilson Latterell, M.D., M.P.H.
• Kaitlyn Leigh Laube Ward, D.P.M.
• Jamie Lawless, CMT
• Lawrence Kotok Leslie Wilcox LLC
• Ava Lawson
• Joseph W Leach, M.D.
• Leah Vancura Therapeutic Services, LLC (Totum Mental Health)
• Karly Louise Learned
• Justin Leatherman
• Lee Medical Inc (LMI Home Medical Equipment)

• Optometrist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.