Eye Klinic Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

MN2869 Issued in MN

Legal business name

EYE KLINIC INC

Doing business as

eyeklinic of edinburgh

Practice address

4620 Oak Grove Pkwy N
Brooklyn Park, MN 55443-4062

Phone

(763) 315-0909

NPI assigned

Nov 30, 2006

Organization subpart

No

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

Authorized official

Name

Josan W. T. KoNPI 1326116344

Title

Ceo

Phone

(763) 315-0909

Specialties & licenses 1

Addresses

Other identifiers 11

Other names 1

• eyeklinic of edinburgh Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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

• Josan Wai-Tak Ko, O.D.

  • Optometrist
  • Brooklyn Park, MN
  • NPI 1326116344
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680048000000",
    "number": "1649348681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 OAK GROVE PKWY N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554434062",
            "telephone_number": "763-315-0909",
            "fax_number": "763-315-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 OAK GROVE PKWY N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554434062",
            "telephone_number": "763-315-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE KLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "JOSAN",
        "authorized_official_middle_name": "W. T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-315-0909"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": "MN2869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "26833",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "19981",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "822081600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "21-00588",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VBA",
            "identifier": "MN02869",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "35135",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "958S7EY",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "191361040082",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PATIENT CHOICE",
            "identifier": "9529921700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VSION",
            "identifier": "J52607",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "181414",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "eyeklinic of edinburgh",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "eyeklinic of edinburgh",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Troy Michael Evenson, PA C
• Evolution Therapy
• Evolve Health and Wellness LLC
• Excel MRI, P.a.
• Excell Academy for Higher Learning
• Gadeeh Fahnbulleh, HOME MAKER
• Fairhavens Home Care
• Fairhavens Home Care
• Fairhavens Home Care LLC
• Fairview Clinics

• Eyewear Supplier in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.