Active NPI
Fifth Avenue of Edina Inc.
- Eyewear Supplier
- Edina, MN
National Provider Identifier
1821243239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- License
- 1456
- Legal business name
- FIFTH AVENUE OF EDINA INC.
- Practice address
- 3540 Galleria
Edina, MN 55435-4218 - Phone
- (952) 922-1052
- Fax
- (952) 922-2518
- NPI assigned
- Nov 26, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gale L Stead, O.D.
- Title
- Owner
- Phone
- (952) 922-1052
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1456 | MN | |
| Eyewear Supplier | 332H00000X | 1456 | MN | Primary |
Addresses
Primary practice location
3540 Galleria
Edina, MN 55435-4218
Mailing address
3540 Galleria
Edina, MN 55435-4218
Phone (952) 922-1052
Other names 1
- FIFTH AVENUE OPTICAL
National Provider Directory
National Provider DirectoryLocations
3540 Galleria
Edina, MN 55435
Phone (952) 922-1052
3625 Galleria
Edina, MN 55435
Phone (952) 922-1052
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227657600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1339545600000",
"number": "1821243239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3540 GALLERIA",
"city": "EDINA",
"state": "MN",
"postal_code": "554354218",
"telephone_number": "952-922-1052",
"fax_number": "952-922-2518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3540 GALLERIA",
"city": "EDINA",
"state": "MN",
"postal_code": "554354218",
"telephone_number": "952-922-1052",
"fax_number": "952-922-2518"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FIFTH AVENUE OF EDINA INC.",
"organizational_subpart": "NO",
"enumeration_date": "2008-11-26",
"last_updated": "2012-06-13",
"status": "A",
"authorized_official_last_name": "STEAD",
"authorized_official_first_name": "GALE",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "952-922-1052",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MN",
"license": "1456",
"primary": false
},
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "MN",
"license": "1456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "FIFTH AVENUE OPTICAL",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.