NPIMap

Organization Active NPI

Lake Region Eye Center

  • Optometrist
  • Alexandria, MN
National Provider Identifier
1528066651
Registry record updated Apr 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
MN2707 Issued in MN
Legal business name
LAKE REGION EYE CENTER
Practice address
610 30TH Ave W
Ste 200
Alexandria, MN 56308-3426
Phone
(320) 763-7055
Fax
(320) 763-2572
NPI assigned
Jul 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2017

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

Authorized official

Name
David SchneiderhanNPI 1306981956
Title
Owner/Optician
Phone
(320) 763-7055

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)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X MN2707 MN Primary

Addresses

Primary practice location

610 30TH Ave W
Ste 200
Alexandria, MN 56308-3426

Mailing address

610 30TH Ave W Ste 200
Alexandria, MN 56308-3426
Phone (320) 763-7055

Other identifiers 5

IdentifierTypeStateIssuer
355300134MedicaidMN
914218500MedicaidMN
597816500MedicaidMN
127518600MedicaidMN
428670300MedicaidMN

National Provider Directory

National Provider Directory

Locations

610 30th Ave W
#200
Alexandria, MN 56308
Phone (320) 763-7055

Practitioners & affiliated clinicians

Practitioners 4

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": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1528066651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 30TH AVE W STE 200",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083426",
            "telephone_number": "320-763-7055",
            "fax_number": "320-763-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 30TH AVE W",
            "address_2": "STE 200",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083426",
            "telephone_number": "320-763-7055",
            "fax_number": "320-763-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE REGION EYE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "SCHNEIDERHAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/OPTICIAN",
        "authorized_official_telephone_number": "320-763-7055"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN2707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355300134",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "914218500",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "597816500",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127518600",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "428670300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.