Ophthalmic Plastic and Reconstructive Surgery, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

799 Issued in MN

Legal business name

OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY, P.A.

Practice address

4887 E Lake Harriet Blvd
Minneapolis, MN 55419-5222

Phone

(612) 325-0317

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Richard P Carroll, M.D.NPI 1407828007

Title

President/Owner

Phone

(612) 325-0317

Specialties & licenses 1

Addresses

Other identifiers 8

Locations

Practitioners 2

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

• Richard Paul Carroll, M.D.

  • Specialist
  • Minneapolis, MN
  • NPI 1407828007
  NPD (past) Authorized official
• Mark V Wedul, MD

  • Ophthalmology Physician
  • Saint Paul, MN
  • NPI 1346294295
  NPD (past)

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272326400000",
    "number": "1386716157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4887 E LAKE HARRIET BLVD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554195222",
            "telephone_number": "612-325-0317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4887 E LAKE HARRIET BLVD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554195222",
            "telephone_number": "612-325-0317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2010-04-27",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "612-325-0317",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MN",
            "license": "799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "122169D805",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7787270",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "95322",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16176",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0802163",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "26128OP",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031010700",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31260500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; 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.