Conroy Eye Care PC
Organization Active NPI Optometrist · Wheaton, MN
NPI 1477720795 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1477720795
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2118 (MN)
- Legal business name
- CONROY EYE CARE PC
- Practice address
- 1011 Broadway
Wheaton, MN 56296-1303 - Phone
- (320) 563-4610
- Fax
- (320) 563-4657
- NPI assigned
- May 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. John Allen Conroy, OD
- Title
- Owner President
- Phone
- (320) 563-4610
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0986999 | Conroy Eye Care PC | Certificate of waiver | May 23, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Conroy Eye Care PC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090114000223 | MN | Part B Supplier - Clinic/Group Practice | 2365425196 |
Receives reassigned benefits from 1 practitioner Practice locations: Wheaton, MN |
| O20100930054846 | MN | DME Supplier - Physician - Optometrist | 2365425196 | Practice locations: Wheaton, MN |
National Provider Directory
- Tax ID family
- Conroy Eye Care PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2118 | MN | Yes |
Addresses
Primary practice location
1011 Broadway
Wheaton, MN 56296-1303
Mailing address
1011 Broadway
Wheaton, MN 56296-1303
Phone (320) 563-4610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4645120001 | Other | MN | DMERC |
| 358723100 | Medicaid | MN |
Other providers in Wheaton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.