Organization Active NPI

Lakes Region Retina PC

  • Retina Specialist (Ophthalmology) Physician
  • Baxter, MN
National Provider Identifier
1376412684
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
LAKES REGION RETINA PC
Practice address
13800 Bluestem CT
Baxter, MN 56425
Phone
(218) 580-4218
Fax
(218) 580-4218
NPI assigned
Nov 4, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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

Authorized official

Name
David F Williams, M.D.NPI 1558359554
Title
Owner, Ceo, President
Phone
(612) 382-8535

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

13800 Bluestem CT
Baxter, MN 56425

Mailing address

13800 Bluestem CT
Baxter, MN 56425-6005
Phone (218) 297-5344

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251230002849 MN Part B Supplier - Clinic/Group Practice 9931695830 Receives reassigned benefits from 1 practitioner
Practice locations: Baxter, MN

National Provider Directory

National Provider Directory

Locations

13800 Bluestem Ct
Baxter, MN 56425
Phone (218) 580-4218

Interoperability endpoints

  • Direct secure messaging: dwilliams@lrr.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1762214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779321600000",
    "number": "1376412684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 BLUESTEM CT",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564256005",
            "telephone_number": "218-297-5344",
            "fax_number": "218-297-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 BLUESTEM CT",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-580-4218",
            "fax_number": "218-580-4218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES REGION RETINA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-04",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER, CEO, PRESIDENT",
        "authorized_official_telephone_number": "612-382-8535",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; 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.