Progressive Eyecare Associates

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

776 Issued in MN

Legal business name

PROGRESSIVE EYECARE ASSOCIATES

Practice address

4625 Churchill Street
Suite 210
Shoreview, MN 55126

Phone

(651) 645-3997

NPI assigned

May 11, 2007

Organization subpart

No

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

Authorized official

Name

Dianna L Kent

Title

Practice Administrator

Phone

(651) 645-3997

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356556500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 UNIVERSITY AVE WEST",
            "address_2": "SUITE 140",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55104",
            "telephone_number": "651-645-3997",
            "fax_number": "651-641-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 CHURCHILL STREET",
            "address_2": "SUITE 210",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "55126",
            "telephone_number": "651-645-3997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE EYECARE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KENT",
        "authorized_official_first_name": "DIANNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "651-645-3997"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CS0820",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0461340002",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Ophthalmology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.