NPIMap

Organization Active NPI

Optometric Eye Care Centers, PA

Doing business as Eye Care Center

  • Optometrist
  • Maplewood, MN
National Provider Identifier
1730203597
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1635 Issued in MN
Legal business name
OPTOMETRIC EYE CARE CENTERS, PA
Doing business as
Eye Care Center
Practice address
1965 11TH Ave E
Suite 101
Maplewood, MN 55109-5167
Phone
(651) 777-3555
Fax
(651) 777-4459
NPI assigned
Mar 19, 2007
Last updated
Apr 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

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

Authorized official

Name
Dr. Gregory W Kraupa, OD
Title
President
Phone
(651) 777-3555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1635 MN Primary

Addresses

Primary practice location

1965 11TH Ave E
Suite 101
Maplewood, MN 55109-5167

Mailing address

1965 11TH Ave E
Suite 101
Maplewood, MN 55109-5167
Phone (651) 777-3555

Other identifiers 3

IdentifierTypeStateIssuer
2115755OtherMNMEDICA MN
581713700MedicaidMN
08072KROtherMNBCBS OF MN PRACTICE GRP

Other names 1

  • Eye Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041012001424 MN Part B Supplier - Clinic/Group Practice 3779543962 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fridley, MN; Maple Grove, MN; Maplewood, MN
O20100930075498 MN DME Supplier - Physician - Optometrist 3779543962 Practice locations: Maplewood, MN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2031738Eye Care Center1965 11TH Avenue East #101, Saint Paul, MN 55109Certificate of waiverOct 25, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Optometric Eye Care C1965 11TH Ave E, Maplewood, MN 55109-5167(651) 777-3555 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1987

National Provider Directory

National Provider Directory
Tax ID family
Eye Care Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7884 Main St N
Maple Grove, MN 55369
Phone (763) 420-6981

1965 11th Ave E
Maplewood, MN 55109
Phone (651) 777-3555

1965 11th Ave E
Ste 101
Saint Paul, MN 55109
Phone (651) 777-3555

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1730203597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1965 11TH AVE E",
            "address_2": "SUITE 101",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095167",
            "telephone_number": "651-777-3555",
            "fax_number": "651-777-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1965 11TH AVE E",
            "address_2": "SUITE 101",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095167",
            "telephone_number": "651-777-3555",
            "fax_number": "651-777-4459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC EYE CARE CENTERS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "KRAUPA",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-777-3555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA MN",
            "identifier": "2115755",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "581713700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN PRACTICE GRP",
            "identifier": "08072KR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.