Larry James Schlauderaff, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

MN2415 Issued in MN

Practice address

202 NW 1St Ave
Grand Rapids, MN 55744-2703

Phone

(218) 326-0358

Fax

(218) 326-0566

NPI assigned

Sep 7, 2007

Last updated

May 22, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 13

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

Specialty

Optometry

Education

Pennsylvania College of Optometry, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eye Fashions Optical Shoppe Inc

  • Optometrist
  • Grand Rapids, MN
  • NPI 1477624971
  Medicare reassignment NPD Authorized official
• Shoptikal LLC

  dba Shopko Optical 4017

  • Eyewear Supplier
  • Saint Cloud, MN
  • NPI 1942866371
  Medicare reassignment Care Compare group
• Shoptikal LLC

  dba Shopko Optical 4242

  • Eyewear Supplier
  • Vadnais Heights, MN
  • NPI 1528650652

  Optometrist

  NPD
• Shoptikal LLC

  dba Fielmann Vision Care 4313

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1477748085",
    "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": "557442703",
            "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": "557442703",
            "telephone_number": "218-326-0358",
            "fax_number": "218-326-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHLAUDERAFF",
        "first_name": "LARRY",
        "middle_name": "JAMES",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-07",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN2415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "3C837EY",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS",
            "identifier": "3C837EY",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "3C838SC",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS",
            "identifier": "3C838SC",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA  GR",
            "identifier": "2200897",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP29720",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINN CARE BLUE PLUS",
            "identifier": "4C427EY",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COPORATE BENEFIT SERV",
            "identifier": "1008835",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "974251008835",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PLAN BLE",
            "identifier": "U33589",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PLAN",
            "identifier": "U33589",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "611825900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED",
            "identifier": "U33589",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devon Rudolph
• Kimberley Ann Ruff, BS
• William L. Rutherford, MD
• Linh Scally, MSW, LICSW
• Dennis F. Scherer, MD
• Lynette Schmidt, MSW LICSW
• Terry David Schmitt, DDS
• Avrielle Jewel Schneider, LADC
• Johanna Ellen Schnell, P.L.A.
• Benjamen Steven Schommer, DPT

• Optometrist in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.