Eye Care Associates of Faribault

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

2204 Issued in MN

Legal business name

EYE CARE ASSOCIATES OF FARIBAULT

Practice address

112 4TH St NW
Faribault, MN 55021-5101

Phone

(507) 334-0011

Fax

(507) 331-0012

NPI assigned

Apr 7, 2009

Last updated

Apr 7, 2009By 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

Dr. David E Malmanger, O.D.

Title

Optometrist/Owner

Phone

(507) 334-0011

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1700029790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 575",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550210575",
            "telephone_number": "507-334-0011",
            "fax_number": "507-331-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 4TH ST NW",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215101",
            "telephone_number": "507-334-0011",
            "fax_number": "507-331-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE ASSOCIATES OF FARIBAULT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-07",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "MALMANGER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "507-334-0011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "2204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099223200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Faribault, MN
• Providers in Faribault, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.