Active NPI
Burt Dubow
- Optometrist
- Waite Park, MN
National Provider Identifier
1407844822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1604
- Practice address
- 206 Division St
Waite Park, MN 56387-1331 - Phone
- (320) 253-0365
- Fax
- (320) 253-9401
- NPI assigned
- Oct 10, 2005
- Last updated
- Dec 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1604 | MN | Primary |
Addresses
Primary practice location
206 Division St
Waite Park, MN 56387-1331
Mailing address
PO Box 7654
Saint Cloud, MN 56302-7654
Phone (320) 253-0365
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2220109 | Other | MN | MEDICA |
| 73001 | Other | MN | PREFERRED ONE |
| T65469 | Other | MN | SELECT CARE |
| 54290DU | Other | MN | BLUE CROSS BLUE SHIELD |
| 14144 | Other | MN | MAYO MTG |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1604 | MN | MD | Certified Registered Nurse Anesthetist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Insight Eye Care
- Durable Medical Equipment & Medical Supplies
- Waite Park, MN
- NPI 1366505323
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196726400000",
"number": "1407844822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7654",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563027654",
"telephone_number": "320-253-0365",
"fax_number": "320-253-9401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 DIVISION ST",
"city": "WAITE PARK",
"state": "MN",
"postal_code": "563871331",
"telephone_number": "320-253-0365",
"fax_number": "320-253-9401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOW",
"first_name": "BURT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-10",
"last_updated": "2007-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1604",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "2220109",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "73001",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SELECT CARE",
"identifier": "T65469",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "54290DU",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAYO MTG",
"identifier": "14144",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waite Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.