Edward Augdahl, O.D.
Individual provider Active NPI Optometrist · Brooklyn Center, MN
NPI 1720056641 · NPPES record last updated May 4, 2009
Key facts
- NPI
- 1720056641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- MN2571 (MN)
- Practice address
- Pearle Vision
5515 Xerxes Ave North
Brooklyn Center, MN 55430 - Phone
- (763) 560-1636
- Fax
- (763) 560-4101
- NPI assigned
- Mar 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5515 Xerxes Ave N
Brooklyn Center, MN 55430-2856
Phone (763) 560-1636
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041204000284 | MN | Practitioner - Optometry | 1759347487 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MN2571 | MN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eda, Inc | Current |
Accepting new patients |
Locations
5515 Xerxes Ave N
Minneapolis, MN 55430
Phone (763) 560-1636
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | MN2571 | MN | Yes |
Addresses
Primary practice location
Pearle Vision
5515 Xerxes Ave North
Brooklyn Center, MN 55430
Mailing address
5515 Xerxes Ave N
Brooklyn Center, MN 55430-2856
Phone (763) 560-1636
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 296N0AU | Other | BCBS | |
| 2203101 | Other | MN | MEDICA |
| 781138100 | Medicaid | MN | |
| MN2571 | Other | MN | EYEMED |
| 24F55PE | Other | MN | BLUE CROSS/BLUE SHIELD |
| 513T1PE | Other | MN | BLUE CROSS/BLUE SHIELD |
| 1720056641 | Other | MN | HEALTHPARTNERS |
| 2260985 | Other | MN | AMERICA'S PPO |
Other providers in Brooklyn Center, MN
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- Nevaeh Arradondo
- Ashton Homes, LLC
- Asian American Elderly Assisted Living
- Rebecca Suzanne Autio
- Autism Solutions Academy LLC
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- Award Home Healthcare LLC
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All providers in Brooklyn Center, 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 May 4, 2009. 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.
- Order and Referring (CMS).
- 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.