NPIMap

Organization Active NPI

Minnesota Optical LLC

Doing business as dba Pearle Vision

  • Optometrist
  • Elk River, MN
National Provider Identifier
1831303437
Registry record updated Mar 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MINNESOTA OPTICAL LLC
Doing business as
dba Pearle Vision
Practice address
19576 Holt St NW
Elk River, MN 55330
Phone
(763) 241-2083
Fax
(763) 241-3801
NPI assigned
May 10, 2007
Last updated
Mar 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2012

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

Authorized official

Name
Gary Tonsager
Title
Chief Officer
Phone
(763) 241-2083

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Optometrist 152W00000X MN Primary

Addresses

Primary practice location

19576 Holt St NW
Elk River, MN 55330

Mailing address

19576 Holt St NW
Elk River, MN 55330
Phone (763) 241-2083

Other identifiers 1

IdentifierTypeStateIssuer
6627600001OtherMNDME

Other names 1

  • dba Pearle Vision Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120127000701 MN DME Supplier - Physician - OptometristDME Supplier - Optician 1557528841 Practice locations: Elk River, MN
O20120221000953 MN Part B Supplier - Clinic/Group Practice 1557528841 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
Practice locations: Elk River, MN

Other NPIs on the same Medicare enrollment 1

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
Pearle Vision19576 Holt St NW, Elk River, MN 55330-1287(763) 241-2083 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Dec 2, 2011

National Provider Directory

National Provider Directory

Locations

19576 Holt St NW
Elk River, MN 55330
Phone (763) 241-2083

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331251200000",
    "number": "1831303437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19576 HOLT ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "55330",
            "telephone_number": "763-241-2083",
            "fax_number": "763-241-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19576 HOLT ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "55330",
            "telephone_number": "763-241-2083",
            "fax_number": "763-241-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2012-03-09",
        "status": "A",
        "authorized_official_last_name": "TONSAGER",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CHIEF OFFICER",
        "authorized_official_telephone_number": "763-241-2083"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "6627600001",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Pearle Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elk River, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2012; 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.