NPIMap

Organization Active NPI

DJ-MN Inc

Doing business as Select Eyecare

  • Optician
  • Coon Rapids, MN
National Provider Identifier
1578615019
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
DJ-MN INC
Doing business as
Select Eyecare
Practice address
11415 Foley Blvd NW
Coon Rapids, MN 55448-2451
Phone
(763) 755-3683
NPI assigned
Jan 17, 2007
Last updated
Dec 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Authorized official

Name
Jane Thelen
Title
Owner
Phone
(763) 427-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X NU Primary

Addresses

Primary practice location

11415 Foley Blvd NW
Coon Rapids, MN 55448-2451

Mailing address

12 Bridge SQ Ste 101
Anoka, MN 55303-2463
Phone (763) 427-4000

Other identifiers 1

IdentifierTypeStateIssuer
037615000MedicaidMN

Other names 1

  • Select Eyecare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070718000701 MN Part B Supplier - Clinic/Group Practice 5496856650 Receives reassigned benefits from 24 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anoka, MN; Coon Rapids, MN; Monticello, MN

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
DJ-MN Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

12 Bridge Sq
Ste 101
Anoka, MN 55303
Phone (763) 421-4334

11415 Foley Blvd NW
Coon Rapids, MN 55448
Phone (763) 755-3683

460 Northdale Blvd NW
Coon Rapids, MN 55448
Phone (763) 754-2122

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1578615019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 BRIDGE SQ STE 101",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032463",
            "telephone_number": "763-427-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11415 FOLEY BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482451",
            "telephone_number": "763-755-3683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DJ-MN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "THELEN",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-427-4000"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037615000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Select Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Select Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coon Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; 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.