NPIMap

Organization Active NPI

Monticello Optical Center Inc.

  • Optometrist
  • Monticello, MN
National Provider Identifier
1629591490
Registry record updated Jul 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MONTICELLO OPTICAL CENTER INC.
Practice address
261 E Broadway St
Monticello, MN 55362-9317
Phone
(763) 295-5292
NPI assigned
Jul 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2017

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

Authorized official

Name
Dr. John Mark Cavanagh, O.D.NPI 1205921368
Title
President
Phone
(651) 636-2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

261 E Broadway St
Monticello, MN 55362-9317

Mailing address

2655 Innsbruck Dr Ste B
New Brighton, MN 55112-9304
Phone (651) 636-2020

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1500854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500854400000",
    "number": "1629591490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 INNSBRUCK DR STE B",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551129304",
            "telephone_number": "651-636-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 E BROADWAY ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553629317",
            "telephone_number": "763-295-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO OPTICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-24",
        "last_updated": "2017-07-24",
        "status": "A",
        "authorized_official_last_name": "CAVANAGH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-636-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.