Community Eye Clinic

Primary specialty

OptometristTaxonomy code 152W00000X

License

LD2140000 Issued in MN

Legal business name

COMMUNITY EYE CLINIC

Practice address

1670 Beam Ave
Ste 202
Maplewood, MN 55109-1129

Phone

(651) 777-6149

NPI assigned

Oct 31, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Larson

Title

Owner

Phone

(651) 777-6149

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225411200000",
    "number": "1417100629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 BEAM AVE",
            "address_2": "STE 202",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 BEAM AVE",
            "address_2": "STE 202",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091129",
            "telephone_number": "651-777-6149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY EYE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-31",
        "last_updated": "2008-10-31",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-777-6149",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "LD2140000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Comfort Care Pca LLC
• Community Connection Support Services LLC
• Community Dental Care
• Community Dental Care Inc (Community Dental Care)
• Community Dental Care Inc
• Elizabeth Ann Conley
• Continuum Care
• Aniya Cook
• Jeffrey Michael Corajod
• Corner Medical LLC

• Optometrist in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.