NPIMap

Organization Active NPI

Bright Eyes Vision Clinic, PA

  • Optometrist
  • Otsego, MN
National Provider Identifier
1720113947
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BRIGHT EYES VISION CLINIC, PA
Practice address
9125 Quaday Ave NE
Suite 104
Otsego, MN 55330-6651
Phone
(763) 241-1090
NPI assigned
Feb 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jill Ak Hadler, OD
Title
Ceo and President
Phone
(763) 241-1090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

9125 Quaday Ave NE
Suite 104
Otsego, MN 55330-6651

Mailing address

9125 Quaday Ave NE
Suite 104
Otsego, MN 55330-6651

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060419000423 MN Part B Supplier - Clinic/Group Practice 1456360403 Receives reassigned benefits from 2 practitioners
Practice locations: Minnetonka, MN; Otsego, MN

National Provider Directory

National Provider Directory

Locations

13889 Ridgedale Dr
Minnetonka, MN 55305
Phone (763) 241-1090

13911 Ridgedale Dr
Ste 115
Minnetonka, MN 55305
Phone (763) 241-1090

15704 90th St NE
#100
Otsego, MN 55330
Phone (763) 241-1090

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720113947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9125 QUADAY AVE NE",
            "address_2": "SUITE 104",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553306651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9125 QUADAY AVE NE",
            "address_2": "SUITE 104",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553306651",
            "telephone_number": "763-241-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT EYES VISION CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HADLER",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "AK",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "763-241-1090",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Otsego, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.