NPIMap

Organization Active NPI

Doffin Family Eye Care PA

Doing business as White Bear Eye Clinic and Optical

  • Optometrist
  • White Bear Lake, MN
National Provider Identifier
1346291630
Registry record updated Sep 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DOFFIN FAMILY EYE CARE PA
Doing business as
White Bear Eye Clinic and Optical
Practice address
4750 Washington SQ
White Bear Lake, MN 55110-3257
Phone
(651) 429-3379
Fax
(651) 429-8681
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2017

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

Authorized official

Name
Julie Olufson
Title
Insurance Manager
Phone
(651) 429-3379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

4750 Washington SQ
White Bear Lake, MN 55110-3257

Mailing address

4750 Washington SQ
White Bear Lake, MN 55110-3257
Phone (651) 429-3379

Other identifiers 6

IdentifierTypeStateIssuer
27679RUOtherMNBLUE CROSS BLUE SHIELD
105474OtherMNUCARE
2200089OtherMNMEDICA
2117748OtherMNMEDICA-DME
29623WHOtherMNBLUE CROSS BLUE SHIELD
307262200MedicaidMN

Other names 1

  • White Bear Eye Clinic and Optical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171016000780 MN Part B Supplier - Clinic/Group Practice 6608142898 Receives reassigned benefits from 4 practitioners
Practice locations: White Bear Lake, MN

National Provider Directory

National Provider Directory

Locations

4750 Washington Sq
White Bear Lk, MN 55110
Phone (651) 429-3379

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506297600000",
    "number": "1346291630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 WASHINGTON SQ",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103257",
            "telephone_number": "651-429-3379",
            "fax_number": "651-429-8681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4750 WASHINGTON SQ",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103257",
            "telephone_number": "651-429-3379",
            "fax_number": "651-429-8681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOFFIN FAMILY EYE CARE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2017-09-25",
        "status": "A",
        "authorized_official_last_name": "OLUFSON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "651-429-3379"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "27679RU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "105474",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2200089",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA-DME",
            "identifier": "2117748",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "29623WH",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307262200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Bear Eye Clinic and Optical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "White Bear Eye Clinic and Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; 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.