Organization Active NPI

Fifth Avenue of Edina Inc.

  • Eyewear Supplier
  • Edina, MN
National Provider Identifier
1821243239
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
1456 Issued in MN
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

Updated by the provider on Jun 13, 2012

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)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 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 Other name

National Provider Directory

National Provider Directory

Locations

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.

Verify at the official NPI Registry.