NPIMap

Organization Active NPI

Cedar Lakes Eye Specialists PA

Doing business as DBA: Origins Eye Clinic

  • Optometrist
  • St Louis Park, MN
National Provider Identifier
1730472523
Registry record updated Apr 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3009 Issued in MN
Legal business name
CEDAR LAKES EYE SPECIALISTS PA
Doing business as
DBA: Origins Eye Clinic
Practice address
5801 W 16TH St
St Louis Park, MN 55416-1446
Phone
(763) 582-9601
Fax
(763) 582-9613
NPI assigned
May 26, 2011
Last updated
Apr 30, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2018

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

Authorized official

Name
Mr. David Bane, OD
Title
Owner
Phone
(763) 582-9601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3009 MN Primary

Addresses

Primary practice location

5801 W 16TH St
St Louis Park, MN 55416-1446

Mailing address

PO Box 1170
Maple Grove, MN 55311-6170
Phone (763) 582-9601

Other names 1

  • DBA: Origins Eye Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1306368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1730472523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1170",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553116170",
            "telephone_number": "763-582-9601",
            "fax_number": "763-582-9613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 W 16TH ST",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161446",
            "telephone_number": "763-582-9601",
            "fax_number": "763-582-9613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR LAKES EYE SPECIALISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-26",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "BANE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-582-9601",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA: Origins Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; 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.