NPIMap

Organization Active NPI

Minnesota Eyecare Network, Inc

Doing business as Azure Vision Care

  • Optometrist
  • Barnesville, MN
National Provider Identifier
1760655740
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MINNESOTA EYECARE NETWORK, INC
Doing business as
Azure Vision Care
Practice address
112 Front Street S
Barnesville, MN 56514-0655
Phone
(218) 354-2510
Fax
(218) 354-2510
NPI assigned
Apr 10, 2008
Last updated
Jun 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

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

Authorized official

Name
Mr. Timothy C Neitzke, O.D.NPI 1033133517
Title
President
Phone
(218) 346-3310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

112 Front Street S
Barnesville, MN 56514-0655

Mailing address

652 Jefferson Street N
Wadena, MN 56482-2307
Phone (218) 631-1456

Other names 1

  • Azure Vision Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040708000690 MN Part B Supplier - Clinic/Group Practice 6608854526 Receives reassigned benefits from 6 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Barnesville, MN; Long Prairie, MN; Pelican Rapids, MN; Perham, MN; Wadena, MN
O20100930084897 MN DME Supplier - Physician - OptometristDME Supplier - Optician 6608854526 Practice locations: Barnesville, MN

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Azure Vision Care112 Front St S, Barnesville, MN 56514-3841(218) 354-2510 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1996

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Eyecare Network I6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1207785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1760655740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 JEFFERSON STREET N",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564822307",
            "telephone_number": "218-631-1456",
            "fax_number": "281-631-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 FRONT STREET S",
            "city": "BARNESVILLE",
            "state": "MN",
            "postal_code": "565140655",
            "telephone_number": "218-354-2510",
            "fax_number": "218-354-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EYECARE NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-10",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "NEITZKE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-346-3310",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Azure Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Barnesville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.