F & G Optical Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

2439 Issued in MN

Legal business name

F & G OPTICAL INC

Practice address

852 Lake St E
Unit a
Wayzata, MN 55391-4523

Phone

(952) 476-4185

Fax

(952) 476-8812

NPI assigned

Nov 9, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Virginia Domain

Title

Cfo

Phone

(952) 476-4185

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Latham Optical Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracy Christensen, OD

  • Optometrist
  • Maple Grove, MN
  • NPI 1568523843
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365379200000",
    "number": "1679643100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 LAKE ST E",
            "address_2": "UNIT A",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553914526",
            "telephone_number": "952-476-4185",
            "fax_number": "952-476-8812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 LAKE ST E",
            "address_2": "UNIT A",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553914523",
            "telephone_number": "952-476-4185",
            "fax_number": "952-476-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "F & G OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-04-08",
        "status": "A",
        "authorized_official_last_name": "DOMAIN",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "952-476-4185",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2439",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808862400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Latham Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Elizabeth Erwin, DPT
• Lucy B Esberg, MD
• Ever-Well Therapy Services
• Excel Dentistry PLLC
• Cynthia A Eyden, PT
• Family and Cosmetic Gentle Dentistry
• Family Eye Clinic & Contact Lens Center
• Rebecca Christine Fichtel, PA-C
• Michelle Annette Finley, MA, LMFT
• Melissa Fjelstad, LADC, LPCC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; 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.