NPIMap

Organization Active NPI

Minnesota Eyecare Network, Inc

  • Optometrist
  • Perham, MN
National Provider Identifier
1407960651
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MINNESOTA EYECARE NETWORK, INC
Practice address
340 Fox Street
Perham, MN 56573-1733
Phone
(218) 346-3310
Fax
(218) 346-3310
NPI assigned
Aug 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

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

Authorized official

Name
Mr. Timothy C Neitzke, O.D.NPI 1033133517
Title
President
Phone
(218) 346-3310

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

340 Fox Street
Perham, MN 56573-1733

Mailing address

652 Jefferson Street
Wadena, MN 56482-2307
Phone (218) 631-1456

Other identifiers 1

IdentifierTypeStateIssuer
299206000MedicaidMN

Other names 1

  • Azure Vision Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040708000690 MN Part B Supplier - Clinic/Group Practice 6608854526 Receives reassigned benefits from 6 practitioners
4 other NPIs on this enrollment
Practice locations: Barnesville, MN; Long Prairie, MN; Pelican Rapids, MN; Perham, MN; Wadena, MN
O20100930051324 MN DME Supplier - Physician - OptometristDME Supplier - Optician 6608854526 1 other NPI on this enrollment
Practice locations: Perham, MN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Eyecare Netwo6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

249 Central Ave
Long Prairie, MN 56347
Phone (320) 732-2002

Practitioners & affiliated clinicians

Practitioners 6

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": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1407960651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 JEFFERSON STREET",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564822307",
            "telephone_number": "218-631-1456",
            "fax_number": "218-631-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 FOX STREET",
            "city": "PERHAM",
            "state": "MN",
            "postal_code": "565731733",
            "telephone_number": "218-346-3310",
            "fax_number": "218-346-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EYECARE NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "NEITZKE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-346-3310",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "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": "299206000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Azure Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perham, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.