St Croix Vision Center Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

LD2763000 Issued in MN

Legal business name

ST CROIX VISION CENTER INC.

Practice address

13481 60TH St N
Suite 200
Stillwater, MN 55082-1055

Phone

(651) 439-6400

Fax

(651) 439-6405

NPI assigned

Sep 28, 2006

Last updated

Aug 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Travis Matthew Johnson, O.D.NPI 1003890609

Title

President

Phone

(651) 439-6400

Specialties & licenses 4

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Travis M. Johnson, O.D.

  • Optometrist
  • Murfreesboro, TN
  • NPI 1003890609
  NPD Authorized official
• Wendy Seyller, OD

  • Optometrist
  • Stillwater, MN
  • NPI 1891881512
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345075200000",
    "number": "1518059526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13481 60TH ST N",
            "address_2": "SUITE 200",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550821055",
            "telephone_number": "651-439-6400",
            "fax_number": "651-439-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13481 60TH ST N",
            "address_2": "SUITE 200",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550821055",
            "telephone_number": "651-439-6400",
            "fax_number": "651-439-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX VISION CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2012-08-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-439-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "LD2763000",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MN",
            "license": "LD2763000",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": "LD2763000",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MN",
            "license": "LD2763000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "904623200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD GR",
            "identifier": "108J4JO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Spine and Sport Chiropractic
• Shelley L Spitzer, OTR
• Sandra Lea Spore, RN DC DABCI DACBN
• St Croix Drug Company
• St Croix Oral, Maxillofacial & Implant Surgery, P.a.
• Jennifer St Sauver
• St. Croix Dermatology, PA
• St. Croix Orthopaedics, P.a. (Orthotic Center)
• St. Croix Orthopaedics, P.a.
• St. Croix Preparatory Academy

• Optometrist in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.