Amj Optometric Services PSC
Organization Active NPI Optometrist · Mankato, MN
NPI 1659635209 · NPPES record last updated Mar 27, 2024
Key facts
- NPI
- 1659635209
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 3175 (MN)
- Legal business name
- AMJ OPTOMETRIC SERVICES PSC
- Practice address
- 111 Star St Ste 101
Mankato, MN 56001-4889 - Phone
- (507) 387-6695
- Fax
- (507) 668-0358
- NPI assigned
- Jun 28, 2012
- Organization subpart
- No
Authorized official
- Name
- Angela Michelle Johnson, OD
- Title
- Ceo
- Phone
- (507) 387-6695
Practitioners 4
-
Laura Coudron, OD
-
Jeffrey Ronald Crowley, O.D.
-
Angela Michelle Johnson, O.D.
-
Timothy Nelson, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120809000577 | MN | Part B Supplier - Clinic/Group Practice | 6901052760 |
Receives reassigned benefits from 3 practitioners Practice locations: Mankato, MN |
National Provider Directory
Locations
1400 Madison Ave
Ste 338
Mankato, MN 56001
Phone (507) 387-6695
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 3175 | MN | Yes |
| Eyewear Supplier | 332H00000X | MN |
Addresses
Primary practice location
111 Star St Ste 101
Mankato, MN 56001-4889
Mailing address
111 Star St Ste 101
Mankato, MN 56001-4889
Phone (507) 387-6695
Other names
- Eye Q Vision
Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.