Vandesteeg & Larson Optometric Clinic, PA
Organization Active NPI Optometrist · Long Prairie, MN
NPI 1669944104 · NPPES record last updated Dec 21, 2018
Key facts
- NPI
- 1669944104
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- VANDESTEEG & LARSON OPTOMETRIC CLINIC, PA
- Practice address
- 240 Central Ave
Long Prairie, MN 56347 - Phone
- (320) 732-2313
- Fax
- (320) 533-3147
- NPI assigned
- Dec 21, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- VANDESTEEG & LARSON OPTOMETRIC CLINIC, PA
Authorized official
- Name
- Mr. Stephen M Larson, OD
- Title
- President
- Phone
- (320) 732-2313
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 2
-
Jonathan Larson, OD
-
Todd Donovan Olson, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Vandesteeg & Larson Optometric Clin |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050712000500 | MN | Part B Supplier - Clinic/Group Practice | 6800822859 |
Receives reassigned benefits from 2 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Glenwood, MN; Long Prairie, MN; Sauk Centre, MN |
| O20100930001171 | MN | DME Supplier - Physician - Optometrist |
6800822859 |
1 other NPI on this enrollment Practice locations: Long Prairie, MN |
National Provider Directory
- Tax ID family
- Vandesteeg Larson Optomet
- Part of
- Vandesteeg Larson Optomet
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
240 Central Ave
Long Prairie, MN 56347
Mailing address
240 Central Ave
Long Prairie, MN 56347
Phone (320) 732-2313
Other providers in Long Prairie, MN
- Melissa Thalken
- Kelsey Thomas
- Todd County Social Services
- Valley View Estates
- Clara Marie Vancura
- Paul E. Vangorp
- Patti Ann Venekamp
- Vida Vital Interpreting Delivering Access
- Kristen Weidner
- Willow Bridge Recovery, LLC
All providers in Long Prairie, MN · Optometrist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2018. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.