Minnesota Optometric Eye Doctor, P.a.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MINNESOTA OPTOMETRIC EYE DOCTOR, P.A.

Practice address

2650 32ND Ave S # Setf3
Grand Forks, ND 58201-6541

Phone

(701) 746-4240

NPI assigned

Aug 14, 2020

Organization subpart

No

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

Authorized official

Name

Eric TylerNPI 1285652826

Title

Owner/Optometrist

Phone

(651) 206-2418

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Minnesota Optometric Eye Doctor, P.a.

  • Optometrist
  • Hastings, MN
  • NPI 1316443542

  8628329992

  Same PAC ID

Tax ID family

Minnesota Optometric Eye Doctor PA2 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.

• Minnesota Optometric Eye Doctor, P.a.

  • Optometrist
  • Hastings, MN
  • NPI 1316443542
  NPD tax ID

Locations

Practitioners 1

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

• Eric Richard Tyler, O. D.

  • Optometrist
  • Wautoma, WI
  • NPI 1285652826

  ND

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1558972349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 32ND AVE S # SETF3",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016541",
            "telephone_number": "701-746-4240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 32ND AVE S # SETF3",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016541",
            "telephone_number": "701-746-4240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 32nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582015911",
            "country_code": "US",
            "telephone_number": "701-746-4240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINNESOTA OPTOMETRIC EYE DOCTOR, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "651-206-2418"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tayaih Miller, PHARMD
• Keith W Millette, MD
• Jennifer Kaye Mills, PMHNP
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• Cassidy A Mindeman, PA
• Miracle Hands Care
• Jessica L Miskavige, DDS
• Lindsey G Miskavige, CF-SLP
• Thomas Christopher Miskavige, MD
• Jennifer Leigh Modeen, LCSW

• Optometrist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.