G.R. Thomas Jr OD PA

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

G.R. THOMAS JR OD PA

Practice address

7880 Mainstreet
Maple Grove, MN 55369-7081

Phone

(763) 420-6981

Fax

(763) 773-7253

NPI assigned

Jan 2, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Alissa Lindstrom, CPO

Title

Insurance Coordinator

Phone

(763) 420-6981

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Maple Grove Eye Clinic Doing business as

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1659556264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7880 MAIN ST N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697081",
            "telephone_number": "763-420-6981",
            "fax_number": "763-773-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7880 MAINSTREET",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697081",
            "telephone_number": "763-420-6981",
            "fax_number": "763-773-7253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G.R. THOMAS JR OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "LINDSTROM",
        "authorized_official_first_name": "ALISSA",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "763-420-6981",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1457",
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "652323400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Grove Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katie Jo Frokjer, DPT
• Elizabeth Anne Fronek, MD
• Fu Wong DDS PA
• Ryan B Fuder, PHARMD.
• Margaret Funk, M.D.
• Taylor Gaikowski, RDN, LD
• Michael A Gallagher, FNP
• Kathleen M Hill Gallant, PHD, RD
• Leya Galvan Smith, RN
• Kyle Gangl, BCBA

• Eyewear Supplier in Maple Grove, MN
• Providers in Maple Grove, 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 4, 2011; 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.