Northeast Eye Care of Hugo

Primary specialty

OptometristTaxonomy code 152W00000X

License

2585 Issued in MN

Legal business name

NORTHEAST EYE CARE OF HUGO

Practice address

14643 Mercantile Blvd
Suite 112
Hugo, MN 55038

Phone

(651) 426-3630

NPI assigned

Mar 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kristi A Iverson, OD

Title

Cfo

Phone

(651) 426-3630

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northeast Eye Care Doing business as

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1437276763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14643 MERCANTILE BLVD",
            "address_2": "SUITE 112",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "55038",
            "telephone_number": "651-426-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14643 MERCANTILE BLVD",
            "address_2": "SUITE 112",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "55038",
            "telephone_number": "651-426-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST EYE CARE OF HUGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2010-05-17",
        "status": "A",
        "authorized_official_last_name": "IVERSON",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-426-3630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226680000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.