Maple Grove Vision Clinic, P.a.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MAPLE GROVE VISION CLINIC, P.A.

Practice address

13645 Grove Dr
Maple Grove, MN 55311-4405

Phone

(763) 420-8030

Fax

(763) 420-8342

NPI assigned

Jul 4, 2006

Organization subpart

No

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

Authorized official

Name

Linda M Thiel

Title

Clinic Administrator

Phone

(763) 420-8030

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 6

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

• Scott A Frick, OD

  • Optometrist
  • Maple Grove, MN
  • NPI 1043214091

  MN, Optometrist

  Medicare reassignment NPD
• J Scott Endres, OD

  • Optometrist
  • Crystal, MN
  • NPI 1205830254
  NPD (past)
• James J Hess, OD

  • Optometrist
  • Litchfield, MN
  • NPI 1689678633
  NPD (past)
• Katie E Olineck, OD

  • Optometrist
  • Maple Grove, MN
  • NPI 1669476610
  NPD (past)
• Gina Marie Wesley, O.D.

  • Optometrist
  • Medina, MN
  • NPI 1992738652
  NPD (past)
• Melissa Phyllis Jones-Hjelden, OD

  • Optometrist
  • Watford City, ND
  • NPI 1912160540
  NPD (past)

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251676800000",
    "number": "1366472342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13645 GROVE DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114405",
            "telephone_number": "763-420-8030",
            "fax_number": "763-420-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13645 GROVE DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114405",
            "telephone_number": "763-420-8030",
            "fax_number": "763-420-8342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE VISION CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2009-08-31",
        "status": "A",
        "authorized_official_last_name": "THIEL",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "763-420-8030"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "762603700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maple Grove Hospital Corporation
• Maple Grove Periodontics and Implant Dentistry
• Maple Grove Smiles Dentistry, PC
• Maple Grove Therapy and Wellness
• Maple Grove Urgent Care
• Maravent Health LLC
• Timothy Blake Markson
• Lynn Marie Marrs, MSW LICSW
• Hanna Marshall, OTD, OTR/L
• Robert S Marshall, M.D.

• All providers in Maple Grove, MN
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; 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.