Granite Falls Eyecare, Inc
Organization Active NPI Optometrist · Ortonville, MN
NPI 1831590777 · NPPES record last updated Sep 10, 2014
Key facts
- NPI
- 1831590777
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2337 (MN)
- Legal business name
- GRANITE FALLS EYECARE, INC
- Practice address
- 128 2ND St NW
Ortonville, MN 56278-1409 - Phone
- (320) 839-3413
- NPI assigned
- Sep 10, 2014
- Organization subpart
- No
Authorized official
- Name
- Todd Trudel
- Title
- Owner
- Phone
- (320) 842-4131
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 2
Practitioners 3
-
Todd E Trudel, O.D.
-
Jacob Peder Bollman, O.D.
-
Kassidy Winther, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040804000737 | MN | Part B Supplier - Clinic/Group Practice | 2163493081 |
Receives reassigned benefits from 3 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Benson, MN; Granite Falls, MN; Ortonville, MN |
National Provider Directory
- Tax ID family
- Granite Falls Eyecare Inc
Locations
219 14th St S
Benson, MN 56215
Phone (320) 774-3666
28 2nd St NW
#101
Ortonville, MN 56278
128 2nd St NW
Ortonville, MN 56278
Phone (320) 839-3413
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2337 | MN | Yes |
Addresses
Primary practice location
128 2ND St NW
Ortonville, MN 56278-1409
Mailing address
128 2ND St NW
Ortonville, MN 56278-1409
Phone (320) 839-3413
Other names
- Ortonville Family Eyecare
Other providers in Ortonville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.