NPIMap

Organization Active NPI

Premier Eye Care, Cottage Grove, LTD

  • Optometrist
  • Cottage Grove, MN
National Provider Identifier
1497792758
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2478 Issued in MN
Legal business name
PREMIER EYE CARE, COTTAGE GROVE, LTD
Practice address
6936 Pine Arbor Dr S Ste 110
Cottage Grove, MN 55016-4672
Phone
(651) 769-1020
Fax
(651) 769-1021
NPI assigned
Jun 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Authorized official

Name
Dr. Jeffrey M Bieter, ODNPI 1962450627
Title
President
Phone
(651) 769-1020

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2478 MN Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

6936 Pine Arbor Dr S Ste 110
Cottage Grove, MN 55016-4672

Mailing address

8617 W Point Douglas Rd S
#110
Cottage Grove, MN 55016-4005
Phone (651) 769-1020

Other names 1

  • Premier Eye Care, Cottage Grove Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060605000027 MN Part B Supplier - Clinic/Group Practice 5395756407 Receives reassigned benefits from 5 practitioners
Practice locations: Cottage Grove, MN

National Provider Directory

National Provider Directory

Locations

6936 Pine Arbor Dr S
Ste 110
Cottage Grove, MN 55016
Phone (651) 769-1020

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1497792758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8617 W POINT DOUGLAS RD S",
            "address_2": "#110",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164005",
            "telephone_number": "651-769-1020",
            "fax_number": "651-769-1021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6936 PINE ARBOR DR S STE 110",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164672",
            "telephone_number": "651-769-1020",
            "fax_number": "651-769-1021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER EYE CARE, COTTAGE GROVE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "BIETER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-769-1020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2478",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Eye Care, Cottage Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cottage Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.

Verify at the official NPI Registry.