Roseau Warroad Eye Clinic PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

ROSEAU WARROAD EYE CLINIC PA

Doing business as

Warroad eye Clinic

Practice address

301 Lake Street
Warroad, MN 56763

Phone

(218) 386-2081

NPI assigned

Oct 7, 2014

Last updated

Oct 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ross Olson, ODNPI 1790071132

Title

Owner/Optometrist

Phone

(218) 463-2020

Specialties & licenses 1

Addresses

Other names 1

• Warroad eye Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Roseau Warroad Eye Clinic PA

  dba Roseau Eye Clinic

  • Optometrist
  • Roseau, MN
  • NPI 1396148839

  O20141017002135

  Same enrollment

Tax ID family

Devaughn Erickson Michael Dieter Partners4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Roseau Warroad Eye Clinic PA

  dba Roseau Eye Clinic

  • Optometrist
  • Roseau, MN
  • NPI 1396148839
  NPD tax ID
• Roseau/Warroad Eye Clinic, P.a.

  • Optometrist
  • Warroad, MN
  • NPI 1861562340
  NPD tax ID
• Roseau/Warroad Eye Clinic, P.a.

  • Optometrist
  • Roseau, MN
  • NPI 1871679456
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ross Olson

  • Optometrist
  • Roseau, MN
  • NPI 1790071132
  Medicare reassignment Care Compare group NPD Authorized official
• Peter Lloyd Vatnsdal, O.D.

  • Optometrist
  • Roseau, MN
  • NPI 1639430689
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1669875514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 MAIN AVE N",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511820",
            "telephone_number": "218-463-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 LAKE STREET",
            "city": "WARROAD",
            "state": "MN",
            "postal_code": "56763",
            "telephone_number": "218-386-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEAU WARROAD EYE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "218-463-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warroad eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michaela Kay Lund, FNP
• Jodie Lynn Meek, PTA
• Northern Lights Family Dentistry,PC
• Rachel Michele Pearce, DNP FNP-C
• Red Lake Band of Chippewa Indians (Red Lake Emergency Response Program (W))
• Roseau/Warroad Eye Clinic, P.a.
• Mark Benjamin Thiele, D.D.S.
• Michael Ernest Thiele, DDS
• James R. Thompson, PHARM D
• Thrifty Drug Stores Inc (Thrifty White Pharmacy #780)

• Optometrist in Warroad, MN
• Providers in Warroad, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.