Eagan Eye Clinic LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EAGAN EYE CLINIC LLC

Practice address

206 Division St
Waite Park, MN 56387-1331

Phone

(320) 235-0365

NPI assigned

Oct 2, 2020

Organization subpart

Yes

Parent organization

EAGAN EYE CLINIC LLCAs reported in NPPES

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

Authorized official

Name

Benjamin S. Chudner, OD

Title

President

Phone

(972) 370-5552

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Part of

Eagan Eye Clinic LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Eagan Eye Clinic LLC

  • Optometrist
  • Eagan, MN
  • NPI 1477732337
  NPPES parent name

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1760089700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E BROADWAY",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026220",
            "telephone_number": "618-462-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 DIVISION ST",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871331",
            "telephone_number": "320-235-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGAN EYE CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGAN EYE CLINIC LLC",
        "enumeration_date": "2020-10-02",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "CHUDNER",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-370-5552",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Marie Dotson
• Ayan Jama Duale III
• Burt Dubow
• Jason Duenas
• Joel R Duray, DDS
• Rachel L Eason
• Leah Alice Egan, CTRS,NBCWHC,ATA
• Evan Eigen, D.C.
• Abigail Elisofon
• Naima Idid Eliyas

• Optometrist in Waite Park, MN
• Providers in Waite Park, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.