Visionary Optical LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3169 Issued in MN

Legal business name

VISIONARY OPTICAL LLC

Practice address

5815 Norell Ave N
Oak Park Heights, MN 55082-1766

Phone

(651) 351-3976

Fax

(651) 351-3978

NPI assigned

Jul 8, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Chad Theodore Bogren, O.D.

Title

Optometrist

Phone

(763) 370-2479

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310083200000",
    "number": "1679860811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 ATWOOD CT",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826692",
            "telephone_number": "763-370-2479",
            "fax_number": "651-351-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5815 NORELL AVE N",
            "city": "OAK PARK HEIGHTS",
            "state": "MN",
            "postal_code": "550821766",
            "telephone_number": "651-351-3976",
            "fax_number": "651-351-3978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISIONARY OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2011-07-08",
        "status": "A",
        "authorized_official_last_name": "BOGREN",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "763-370-2479",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Oak Park Heights, MN
• Providers in Oak Park Heights, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; 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.