John Kloster

Primary specialty

OptometristTaxonomy code 152W00000X

License

2316 Issued in MN

Legal business name

JOHN KLOSTER

Doing business as

Pequot Eye Center

Practice address

4461 Main St,
Pequot Lakes, MN 56472

Phone

(218) 568-5555

Fax

(218) 568-8904

NPI assigned

Apr 7, 2008

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Kloster Nels Kloster, O,D,

Title

Owner

Phone

(218) 568-5555

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Pequot Eye Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Todd M Wiedell, O.D.

  • Optometrist
  • Pequot Lakes, MN
  • NPI 1295781425
  NPD (past)

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

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1396918884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 176",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564720176",
            "telephone_number": "218-568-5555",
            "fax_number": "218-568-8904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4461 MAIN ST,",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "56472",
            "telephone_number": "218-568-5555",
            "fax_number": "218-568-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN KLOSTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "KLOSTER",
        "authorized_official_first_name": "JOHN KLOSTER",
        "authorized_official_middle_name": "NELS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-568-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O,D,"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "64756PE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2220699",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050325800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pequot Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joshua Alan Dietze, DC
• Darren Lee Golden, RPH
• Mindy Sue Howard
• Nadine Indihar, DC
• Inmotion Physical Therapy LLC
• Joyce E. Neuman & Dean S. Brandt PTRS. (Expressions)
• Lakes Area Pharmacy (Lakes Area Pharmacy Inc)
• Lakes Dental Care PLC
• Lelwica Chiropractic
• Michelle Rae Lelwica, D.C.

• Optometrist in Pequot Lakes, MN
• Providers in Pequot Lakes, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.