NPIMap

Organization Active NPI

Picken Welder Optometry, P.C.

  • Optometrist
  • Moorhead, MN
National Provider Identifier
1639611791
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
186 Issued in MN
Legal business name
PICKEN WELDER OPTOMETRY, P.C.
Practice address
725 Center Ave
Ste 2
Moorhead, MN 56560-1958
Phone
(218) 233-2650
Fax
(218) 233-2928
NPI assigned
Nov 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Authorized official

Name
Dr. Jace Hunter Picken, O.D.NPI 1194755249
Title
Optometrist
Phone
(218) 233-2650

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 186 MN Primary

Addresses

Primary practice location

725 Center Ave
Ste 2
Moorhead, MN 56560-1958

Mailing address

725 Center Ave
Ste 2
Moorhead, MN 56560-1958
Phone (218) 233-2650

Other names 1

  • Prairie Vision Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170127000261 MN Part B Supplier - Clinic/Group Practice 0840572822 Receives reassigned benefits from 2 practitioners
Practice locations: Moorhead, MN
O20170510000895 MN DME Supplier - Optician 0840572822 Practice locations: Moorhead, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1639611791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 CENTER AVE",
            "address_2": "STE 2",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565601958",
            "telephone_number": "218-233-2650",
            "fax_number": "218-233-2928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 CENTER AVE",
            "address_2": "STE 2",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565601958",
            "telephone_number": "218-233-2650",
            "fax_number": "218-233-2928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICKEN WELDER OPTOMETRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "PICKEN",
        "authorized_official_first_name": "JACE",
        "authorized_official_middle_name": "HUNTER",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "218-233-2650",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Vision Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Moorhead, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; 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.