Individual provider Active NPI

John Mueller

  • Optometrist
  • Maple Grove, MN
National Provider Identifier
1659728756
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3465 Issued in MN
Practice address
13195 Weaver Lake Rd
Maple Grove, MN 55369-9410
Phone
(763) 420-5112
NPI assigned
May 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3465 MN Primary

Addresses

Primary practice location

13195 Weaver Lake Rd
Maple Grove, MN 55369-9410

Mailing address

13195 Weaver Lake Rd
Maple Grove, MN 55369-9410
Phone (763) 420-5112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160808000543 MN Practitioner - Optometry 5890089247 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4190 Vinewood LN N
Suite 109
Plymouth, MN 55442-1771
Phone (763) 559-5522

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3465MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Brokea Inc. Optometrist CurrentSince Aug 1, 2016 Accepting new patients
John Mueller OD PC Optometrist CurrentSince Oct 30, 2020 Accepting new patients

Locations

13195 Weaver Lake Rd
Maple Grove, MN 55369
Phone (763) 420-5112

4190 Vinewood Ln N
Ste 109
Plymouth, MN 55442
Phone (763) 551-1425

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463529600000",
    "number": "1659728756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 WEAVER LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553699410",
            "telephone_number": "763-420-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13195 WEAVER LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553699410",
            "telephone_number": "763-420-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUELLER",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-18",
        "last_updated": "2016-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.