NPIMap

Organization Active NPI

20-20 Optical Inc

  • Eyewear Supplier
  • Fergus Falls, MN
National Provider Identifier
1619972734
Registry record updated Jul 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
20-20 OPTICAL INC
Practice address
615 S Mill St
Ste 2
Fergus Falls, MN 56537-2756
Phone
(218) 998-2020
Fax
(218) 998-2098
NPI assigned
Jun 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2009

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

Authorized official

Name
Mr. David G. GaustadNPI 1720316409
Title
Owner/Manager
Phone
(218) 998-2020

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X MN
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

615 S Mill St
Ste 2
Fergus Falls, MN 56537-2756

Mailing address

615 S Mill St
Ste 2
Fergus Falls, MN 56537-2756
Phone (218) 998-2020

Other identifiers 8

IdentifierTypeStateIssuer
031024003MedicaidMN
4C789TWOtherMNBLUE CROSS BLUE SHIELD MN
892886OtherNDND VISION SERVICES
21-00143MedicaidTX
55387MedicaidND
VMN000233OtherAZAVESIS
1046788OtherPREFERRED ONE
985222100MedicaidMN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1619972734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S MILL ST",
            "address_2": "STE 2",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372756",
            "telephone_number": "218-998-2020",
            "fax_number": "218-998-2098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S MILL ST",
            "address_2": "STE 2",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372756",
            "telephone_number": "218-998-2020",
            "fax_number": "218-998-2098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "20-20 OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "GAUSTAD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "218-998-2020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031024003",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "4C789TW",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND VISION SERVICES",
            "identifier": "892886",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21-00143",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55387",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "VMN000233",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1046788",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "985222100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; 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.