Minnesota Vision Outreach, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

1706 Issued in MN

Legal business name

MINNESOTA VISION OUTREACH, INC

Practice address

9905 45TH Avenue North
Suite 110
Plymouth, MN 55422-3315

Phone

(763) 595-8414

Fax

(763) 595-8414

NPI assigned

May 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Wolfson, O.D.

Title

Owner

Phone

(763) 585-8414

Specialties & licenses 1

Addresses

Other identifiers 8

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Erin Carlson, OD

  • Optometrist
  • Eagan, MN
  • NPI 1174528608
  NPD (past)

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

{
    "created_epoch": "1178323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478736000000",
    "number": "1457563827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9905 45TH AVENUE NORTH",
            "address_2": "SUITE 110",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554223315",
            "telephone_number": "763-595-8414",
            "fax_number": "763-595-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9905 45TH AVENUE NORTH",
            "address_2": "SUITE 110",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554223315",
            "telephone_number": "763-595-8414",
            "fax_number": "763-595-8414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA VISION OUTREACH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-05",
        "last_updated": "2016-11-10",
        "status": "A",
        "authorized_official_last_name": "WOLFSON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-585-8414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "2100002",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "23979",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS",
            "identifier": "3C780MI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "2115998",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "102877",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096744100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "19467WO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHP",
            "identifier": "2499537",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; 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.