Individual provider Active NPI

Eric Jack-Mun Bohjanen, O.D.

  • Optometrist
  • Duluth, MN
National Provider Identifier
1477512697
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3420 Issued in MN
Practice address
2106 London Rd
Duluth, MN 55812-2127
Phone
(218) 522-4645
Fax
(218) 481-7811
NPI assigned
Mar 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X 3420 MN
Eyewear Supplier 332H00000X 3420 MN
Optometrist 152W00000X 3420 MN Primary

Addresses

Primary practice location

2106 London Rd
Duluth, MN 55812-2127

Mailing address

2106 London Rd
Duluth, MN 55812-2127
Phone (218) 522-4645

Other practice location 1

2145 Academy Cir
Colorado Springs, CO 80909-1658
Phone (719) 574-7000

Other identifiers 2

IdentifierTypeStateIssuer
1477512697MedicaidMN
H400321094OtherMNINDIVIDUAL PTAN

Other names 1

  • Eric J Bohjanen Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160829003290 MN Practitioner - Optometry 4082649157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2106 London Rd
Duluth, MN 55812-2127
Phone (218) 522-4645

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3420MNMDOptician

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1477512697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 LONDON RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558122127",
            "telephone_number": "218-522-4645",
            "fax_number": "218-481-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 LONDON RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558122127",
            "telephone_number": "218-522-4645",
            "fax_number": "218-481-7811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2145 Academy Cir",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809091658",
            "country_code": "US",
            "telephone_number": "719-574-7000",
            "fax_number": "719-597-1712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOHJANEN",
        "first_name": "ERIC",
        "middle_name": "JACK-MUN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "MN",
            "license": "3420",
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": "3420",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477512697",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PTAN",
            "identifier": "H400321094",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIC",
            "last_name": "BOHJANEN",
            "middle_name": "J",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.