Falls Optical, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2809 Issued in MN

Legal business name

FALLS OPTICAL, INC.

Practice address

1850 1St Ave NE
Little Falls, MN 56345-3381

Phone

(320) 632-2391

Fax

(320) 632-2392

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ken D Dodge, OD

Title

President

Phone

(320) 224-5936

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 2

• St. Cloud Vision Clinic, Inc. Former legal business name
• Pierz Eyecare Other name

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bradley Louis Adams, O.D.

  • Optometrist
  • Brainerd, MN
  • NPI 1477652212
  Medicare reassignment NPD
• Matthew Anderson, OD

  • Optometrist
  • Saint Cloud, MN
  • NPI 1225664592
  Medicare reassignment NPD
• Kenneth Dodge, OD

  • Optometrist
  • Little Falls, MN
  • NPI 1346387503
  Medicare reassignment NPD
• Andrew Sabir, OD

  • Optometrist
  • Brainerd, MN
  • NPI 1780431965
  Medicare reassignment NPD

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1356563803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 1ST AVE NE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453381",
            "telephone_number": "320-632-3291",
            "fax_number": "320-632-2392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 1ST AVE NE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453381",
            "telephone_number": "320-632-2391",
            "fax_number": "320-632-2392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112B Main St S",
            "address_purpose": "LOCATION",
            "city": "Pierz",
            "state": "MN",
            "postal_code": "563644400",
            "country_code": "US",
            "telephone_number": "320-468-2020",
            "fax_number": "320-468-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FALLS OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "DODGE",
        "authorized_official_first_name": "KEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-224-5936",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "173486",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "41-0049674",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "257J6CL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2203387",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "520042300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Cloud Vision Clinic, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "St. Cloud Vision Clinic, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Pierz Eyecare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nicole A Ebnet, PHARMD
• David Earl Edgerton Jr., D.O.
• Effective Living Center, Inc
• Daniel Enderlin, D.P.M.
• Falls Court Dentists PA
• Family Chiropractic Center of Little Falls, P.a.
• FCSL Little Falls, LLC
• FCSL Little Falls, LLC
• Kristy L Feia
• Kelly Fenstermacher, O.D.

• Optometrist in Little Falls, MN
• Providers in Little Falls, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.