Agassiz Optometry Associates PC
Organization Active NPI Optometrist · Crookston, MN
NPI 1740567494 · NPPES record last updated Apr 23, 2014
Key facts
- NPI
- 1740567494
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2964 (MN)
- Legal business name
- AGASSIZ OPTOMETRY ASSOCIATES PC
- Practice address
- 216 S Main St
Crookston, MN 56716-1939 - Phone
- (218) 281-2020
- NPI assigned
- Nov 9, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Matthew C Forgit, O.D.
- Title
- Optometrist
- Phone
- (218) 281-2020
Practitioners 3
-
Matthew C Forgit, O.D.
-
Angela Sue Smith, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120727000519 | MN | DME Supplier - Physician - Optometrist | 6507022092 | Practice locations: Crookston, MN |
| O20120830000387 | MN | Part B Supplier - Clinic/Group Practice | 6507022092 |
Receives reassigned benefits from 3 practitioners Practice locations: Crookston, MN; Fosston, MN |
National Provider Directory
Locations
216 S Main St
Ste 2
Crookston, MN 56716
Phone (218) 281-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2964 | MN | Yes |
Addresses
Primary practice location
216 S Main St
Crookston, MN 56716-1939
Mailing address
216 S Main St
Crookston, MN 56716-1939
Phone (218) 281-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6691490001 | Other | MN | DMERC |
Other names
- Crookston Eye Clinic
Other providers in Crookston, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2014. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.