Active NPI
Eye Fashions Optical Shoppe Inc
- Optometrist
- Grand Rapids, MN
National Provider Identifier
1477624971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2415
- Legal business name
- EYE FASHIONS OPTICAL SHOPPE INC
- Practice address
- 202 NW 1St Ave
Grand Rapids, MN 55744 - Phone
- (218) 326-0358
- Fax
- (218) 999-0067
- NPI assigned
- Nov 13, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Larry James Schlauderaff, OD
- Title
- Owner Optometrist
- Phone
- (218) 326-0358
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2415 | MN | Primary |
Addresses
Primary practice location
202 NW 1St Ave
Grand Rapids, MN 55744
Mailing address
202 NW 1St Ave
Grand Rapids, MN 55744
Phone (218) 326-0358
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| U33589 | Other | FIRSTPLAN | |
| 1008835 | Other | COPORATE BENEFIT SERV | |
| U33589 | Other | FIRSTPLANBLUE | |
| 2200897 | Other | MEDICA GR EX | |
| 3C837EY | Other | BLUE SHIELD | |
| HP29720 | Other | HEALTHPARTNERS | |
| 3C837EY | Other | BLUE PLUS | |
| 3C838SC | Other | BLUE PLUS | |
| 4C427EY | Other | BLUE PLUS | |
| 974251008835 | Other | CBSA PPO | |
| 3C838SC | Other | BLUE SHIELD | |
| 4C427EY | Other | MN | MINN CARE BLUE PLUS |
| 593932000 | Medicaid | MN | |
| 974251008835 | Other | PREFERRED ONE | |
| U33589 | Other | EYEMED |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
202 NW 1st Ave
Grand Rapids, MN 55744
Phone (218) 326-0358
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Grand Rapids, MN
- NPI 1477748085
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732492800000",
"number": "1477624971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 NW 1ST AVE",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "55744",
"telephone_number": "218-326-0358",
"fax_number": "218-326-0566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 NW 1ST AVE",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "55744",
"telephone_number": "218-326-0358",
"fax_number": "218-999-0067"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYE FASHIONS OPTICAL SHOPPE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-13",
"last_updated": "2024-11-25",
"certification_date": "2024-11-25",
"status": "A",
"authorized_official_last_name": "SCHLAUDERAFF",
"authorized_official_first_name": "LARRY",
"authorized_official_middle_name": "JAMES",
"authorized_official_title_or_position": "OWNER OPTOMETRIST",
"authorized_official_telephone_number": "218-326-0358",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MN",
"license": "2415",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTPLAN",
"identifier": "U33589",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COPORATE BENEFIT SERV",
"identifier": "1008835",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTPLANBLUE",
"identifier": "U33589",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA GR EX",
"identifier": "2200897",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "3C837EY",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP29720",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE PLUS",
"identifier": "3C837EY",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE PLUS",
"identifier": "3C838SC",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE PLUS",
"identifier": "4C427EY",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CBSA PPO",
"identifier": "974251008835",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "3C838SC",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MINN CARE BLUE PLUS",
"identifier": "4C427EY",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "593932000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "974251008835",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "U33589",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.