NPIMap

Organization Active NPI

Moose Lake Eye Care LLC

  • Optometrist
  • Moose Lake, MN
National Provider Identifier
1548580228
Registry record updated Jun 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2979 Issued in MN
Legal business name
MOOSE LAKE EYE CARE LLC
Practice address
312 Elm Ave
Moose Lake, MN 55767-7706
Phone
(218) 485-8495
Fax
(218) 485-8498
NPI assigned
Jun 4, 2010
Last updated
Jun 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2010

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

Authorized official

Name
Dr. Sasha Niranjali Narayan, O.D.NPI 1275582421
Title
President
Phone
(218) 485-8495

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
Optometrist 152W00000X 2979 MN Primary

Addresses

Primary practice location

312 Elm Ave
Moose Lake, MN 55767-7706

Mailing address

312 Elm Ave
Moose Lake, MN 55767-7706
Phone (218) 485-8495

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110218000074 MN Part B Supplier - Clinic/Group Practice 1557542982 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Hinckley, MN; Moose Lake, MN
O20120508000252 MN DME Supplier - Physician - Optometrist 1557542982 Practice locations: Moose Lake, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2093833Moose Lake Eye Care312 Elm Ave, Moose Lake, MN 55767Certificate of waiverApr 5, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Northern Minnesota Eye Care LLC312 Elm Ave, Moose Lake, MN 55767-7706(218) 485-8495 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Dec 1, 2010

National Provider Directory

National Provider Directory
Tax ID family
Moose Lake Eye Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275609600000",
    "number": "1548580228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 ELM AVE",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557677706",
            "telephone_number": "218-485-8495",
            "fax_number": "218-485-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 ELM AVE",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557677706",
            "telephone_number": "218-485-8495",
            "fax_number": "218-485-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE LAKE EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2010-06-04",
        "status": "A",
        "authorized_official_last_name": "NARAYAN",
        "authorized_official_first_name": "SASHA",
        "authorized_official_middle_name": "NIRANJALI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-485-8495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moose Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.